title: Enteral nutrition to suppress postoperative Crohn's disease recurrence: a five-year prospective cohort study.
abstract: OBJECTIVE
  The aim of this study was to investigate the long-term effect of enteral nutrition (EN) as a maintenance therapy in Crohn's disease (CD) patients following surgery.
  
  
  METHODS
  This study was an extension of our previous study to prolong the duration of intervention and follow-up from 1 to 5 years. Forty consecutive patients who underwent resection for ileal or ileocolic CD were included. Following surgery, 20 patients received continuous elemental diet infusion during the nighttime plus a low-fat diet during the daytime (EN group). Another 20 patients received neither nutritional therapy nor food restriction (control group). All patients were followed for 5 years after operation. No patient received corticosteroid, immunosuppressants, or infliximab except patients who developed recurrence. The end point of this study was recurrence requiring biologic therapy or reoperation. Recurrence rates were analyzed on an intention-to-treat basis.
  
  
  RESULTS
  In the EN group, four patients could not continue tube intubation for elemental diet intake. Two patients (10 %) in the EN group and nine patients (45 %) in the control group developed recurrence requiring infliximab therapy (P = 0.03). The cumulative recurrence incidence rate requiring infliximab was significantly lower in the EN group vs the control group (P = 0.02). One patient (5 %) in the EN group and five patients (25 %) in the control group required reoperation for recurrence (P = 0.18). The cumulative incidence of reoperation was lower in the EN group vs the control group, the difference not being significant (P = 0.08).
  
  
  CONCLUSIONS
  The outcomes of this study suggest that EN therapy reduces the incidence of postoperative CD recurrence.
authors.affiliation: Inflammatory Bowel Disease Center and Department of Surgery, Yokkaichi Social Insurance Hospital, 10-8 Hazuyamacho, Yokkaichi, Mie 510-0016, Japan. nao-taka@sannet.ne.jp
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiraki
authors.forename: Maki
authors.initials: M
authors.lastname: Nakahigashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Umegae
authors.forename: Koichi
authors.initials: K
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001691:Biological Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000517:prevention & control* / Q000601:surgery*; D004724:Endoscopy; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D006801:Humans; D007249:Inflammation; D000069285:Infliximab; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation
chemical_list: D000911:Antibodies, Monoclonal; D000069285:Infliximab