Inducing remission in Inflammatory Bowel Disease: Exclusive Eneteral Nutrition

Emerging evidence suggests that Exclusive Eneteral Nutrition (EEN) could help induce remission in people with active Crohn's Disease (CD). There is limited evidence at the moment for its efficacy for people with Ulcerative Colitis (UC).


EEN refers to providing 100% of an individual's nutrition requirements via oral nutrition supplements. Oral nutrition supplements refers to products such as Sustagen, Ensure, Fortisip, Fresubin and more. These products are nutritionally complete - meaning it contains all the macro and micronutrients your body needs to survive and therefore you can live just consuming them. However, due to the restrictive nature and complexity of the IBD - you should only do EEN with the guidance of an Accredited Practising Dietitian and also support of your treating team.


How does it work?

  • Your dietitian will determine the type and number of nutrition supplements.

  • You are expected to remain on EEN for at least 6-8 weeks.

  • Apart from the oral nutrition supplements, you are allowed water and small volumes of liquids such as clear broth, weak tea (no milk). No food is allowed.

  • Your dietitian will register to you the suppliers of the oral nutrition supplements. They are available in a range of flavours and volumes - so we will work with you to determine which works best for you.

  • After 6-8 weeks, your dietitian will assist you with food introduction over a course of a couple of weeks, depending on your tolerance.

When is EEN used?

  • Active disease

  • When first-line treatment is not working

  • Help to achieve appropriate weight and BMI

  • Pre-operative optimisation

  • Obstructive symptoms

  • Strictures

  • Fistulas

  • Malnutrition

Warning: Doing a “liquid diet” or “juice diet” does NOT achieve the same results and often causes harm.


What's next?

Before booking an appointment with our dietitian, speak with your treating team first (e.g. Gastroenterologist) if EEN is appropriate for you. If you have any further questions, please do not hesitate to contact us.



Helpful websites:

https://www.crohnscolitisfoundation.org/diet-and-nutrition/nutritional-support-therapy

https://www.childrenshospital.org/conditions-and-treatments/treatments/een


Reference

Heerasing N, Thompson B, Hendy P, Heap GA, Walker G, Bethune R, Mansfield S, Calvert C, Kennedy NA, Ahmad T, Goodhand JR. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease. Aliment Pharmacol Ther. 2017 Mar;45(5):660-669. doi: 10.1111/apt.13934. Epub 2017 Jan 20. PMID: 28105752.


Day, A., Wood, J., Melton, S. and Bryant, R.V. (2020), Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease. JGH Open, 4: 260-266. https://doi.org/10.1002/jgh3.12256