[Enteral nutrition in acute Crohn disease]

High-dose corticosteroids remain the gold standard of therapy in acute Crohn's disease, but is associated with a variety of side effects. Nutritional therapy could be an interesting alternative, but corticosteroids are meant to be significantly superior according to efficacy. Published studies, identified by references, MEDLINE and meta-analysis, were evaluated for efficacy of nutritional therapy in acute Crohn's disease. In 18 evaluable of 38 identified publications, 571 patients were treated with nutritional therapy: 295 received elemental diet, 214 oligopeptide diet and 62 polymeric diet. Remission rates were 60%, 55% and 66% respectively. However, only intention-to-treat-analysis was performed in all the studies. When correcting for patients who really were treated with nutritional therapy, remission rates were substantially better: 73%, 70% and 67% respectively, thus comparable with that of corticosteroids. Positive predictors for successful treatment were stenosing disease and low ESR. Remission seems to last as long as after corticosteroid treatment, when a reinduction diet is performed. Negative aspects of nutritional therapy are poor tolerance and higher costs. Perspectives for the future aim on broadening of indications, improving acceptance (by adjuvant instead of exclusive nutrition, or new flavors) and efficacy by modification of compounds (such as glutamine, omega-3 fatty acids or trace elements) or combination with other therapeutic agents (e.g., mesalamine).