Nutritional support for severe malnutrition in newly diagnosed Crohn's disease: a case report

Crohn's disease (CD) and ulcerative colitis are chronic inflammatory bowel diseases (IBDs) characterized by relapsing exacerbations related to a dysregulated immune response, resulting primarily in gastrointestinal symptoms and also frequently in signs of chronic systemic inflammation. Malnutrition is a possible complication of IBD with a prevalence ranging from 20 to 85%, varying with disease activity, location, and age, and is recognized as having a multifactorial pathogenesis. Malnutrition in patients with IBD should be diagnosed early and treated appropriately because it can heavily affect patient prognosis, including complications, hospitalization rates, mortality, and overall quality of life. Therefore, patients with IBD should be screened for malnutrition at diagnosis and regularly thereafter. Moreover, assessing micronutrient deficiencies in patients with IBD is recommended ideally during clinical and biochemical remission. We reported the case of a 56-year-old female patient admitted to our department who reported chronic diarrhea for several months, along with recurrent abdominal pain, low-grade evening fever, nausea, hyporexia, and significant involuntary weight loss, with probable sarcopenia. Iron-deficiency anemia, an elevated platelet count, elevated inflammatory markers, and some oligoelement deficiencies were observed on blood tests. A diagnosis of extensive ileo-colonic CD (A3, L3, B1 according to the Montreal classification) complicated by a perianal abscess and simple intrasphincteric fistula, requiring surgery, was made during the hospitalization. As agreed with our nutritional team, given the severe malnutrition observed in patients at risk of refeeding syndrome, the patient received thiamine supplementation, minimal enteral feeding with oral nutritional supplements (ONS), and simultaneous parenteral nutrition with a ternary emulsion supplemented with vitamins and trace elements. Parenteral nutritional supplementation and ONS were continued for 2 months after discharge to improve the patient's nutritional status. Subsequently, the patient was able to eat only natural foods, as advised by our hospital's nutrition team. Finally, we briefly reviewed recommendations on malnutrition screening and enteral or parenteral nutrition in patients with IBD to reduce morbidity and mortality due to malnutrition.