Preventive effect of nutritional therapy against postoperative recurrence of Crohn disease, with reference to findings determined by intra-operative enteroscopy.
OBJECTIVE
The aim of this study was to elucidate the predictive value of intra-operative enteroscopy (IOE) and the effect of enteral nutrition (EN) with regard to the postoperative recurrence of Crohn disease (CD).


METHODS
Forty patients requiring surgery for severe intestinal complications of CD were examined by IOE, and the severity of the remnant small intestine was determined. Patients were subclassified into either an EN group (>1,200 kcal/day) or a non-EN group (<1,200 kcal/day) according to the amount of daily EN intake after surgery. Contributions of IOE findings and EN to postoperative recurrence were analysed retrospectively.


RESULTS
IOE identified intestinal lesions in 39 patients and active intestinal lesions in 24 patients. The cumulative rate of postoperative recurrence was significantly higher in patients with cobblestone appearance confirmed by IOE (p=0.006). However, other active intestinal lesions were not related to postoperative recurrence. EN reduced the cumulative rate of postoperative recurrence (p=0.017), especially in patients with penetrating type (p=0.005), in patients who did not have colitis (p=0.051) and in patients who did not have active intestinal lesions confirmed by IOE (p=0.02).


CONCLUSIONS
EN is a prophylactic that prevents the postoperative recurrence of small intestinal CD. Patients with the penetrating type of CD, and those who do not have active lesions in the small intestine according to IOE, are candidates for EN after surgery.
Esaki
Motohiro
M
Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan. mesaki@intmed2.med.kyushu-u.ac.jp
Matsumoto
Takayuki
T
Hizawa
Kazuoki
K
Nakamura
Shotaro
S
Jo
Yukihiko
Y
Mibu
Ryuichi
R
Iida
Mitsuo
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000473:pathology* / Q000517:prevention & control* / Q000601:surgery; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome