Relationship between nutritional therapy and surgery in Crohn's disease.
OBJECTIVE
Crohn's disease is often refractory and some patients require repeated surgical treatment. Nutritional therapy with an elemental diet has been reported effective in improving nutritional state and suppressing inflammation, and might be expected to assist in minimizing the need for surgery. We evaluated the relationship between an elemental diet and the period that patients spent without intestinal resection.


METHODS
A total of 153 patients with Crohn's disease who visited our hospital from July, 1999 to July, 2005 were enrolled. The relationship between the caloric content of an elemental diet and surgery as an endpoint was examined using Cox regression analysis. Cumulative non-operation rates were calculated by the Kaplan-Meier method. Statistical significance was determined using the log-rank test.


RESULTS
Among patients with jejunoileal involvement, patients receiving an elemental diet providing 900 kcal or more per day showed a statistically significant improvement in cumulative non-operation rate. Among those without jejunoileal involvement, in contrast, the cumulative non-operation rate did not differ among those receiving an elemental diet of less or more than 900 kcal per day.


CONCLUSIONS
The use of an elemental diet of 900 kcal per day may be effective in avoiding surgery in patients with jejunoileal lesions. This diet may be useful in improving long-term convalescence in these patients.
Takahashi
Hironao
H
Department of Gastroenterology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Ando
Takafumi
T
Watanabe
Osamu
O
Maeda
Osamu
O
Ishiguro
Kazuhiro
K
Ishikawa
Daisuke
D
Hasegawa
Motofusa
M
Minami
Masaaki
M
Goto
Yasuyuki
Y
Kusugami
Kazuo
K
Ina
Kenji
K
Ohmiya
Naoki
N
Niwa
Yasumasa
Y
Goto
Hidemi
H
D000328:Adult; D003424:Crohn Disease / Q000178:diet therapy* / Q000601:surgery*; D002149:Energy Intake; D005260:Female; D006801:Humans; D008297:Male; D044623:Nutrition Therapy / Q000009:adverse effects / Q000379:methods*; D016016:Proportional Hazards Models; D016896:Treatment Outcome