title: Role of exclusive enteral nutrition in the preoperative optimization of patients with Crohn's disease following immunosuppressive therapy.
abstract: We conducted a study to evaluate the impact of the exclusive enteral nutrition (EEN) on perioperative outcome in Crohn's disease (CD) patients following immunosuppressive therapy. Patients with CD followed at a referral center between January 2001 and March 2014 who underwent abdominal surgery were identified. Patients were divided into 4 groups: patients not exposed to immunosuppressive agents in the previous 8 weeks before surgery (group 1); patients received immunosuppressive medications without preoperative drug-free interval (group 2); patients had preoperative immunosuppressants-free interval (group 3); patients treated with adding EEN to preoperative immunosuppressants-free interval regimen (group 4). Urgent operation requirement, stoma creation, postoperative complications, readmission, and reoperation were compared in patients among groups. Overall, 708 abdominal surgeries performed in 498 CD patients were identified. Three hundred seventy-six (53.11%) surgeries performed in those receiving preoperative immunosuppressive medications. Compared with other groups, group 2 had increased postoperative complications, more frequent urgent operation, and higher rate of stoma creation. Patients in group 4 were found to have better outcome including lower rate of stoma creation (P < 0.05), and decreased incidence of postoperative complications (P < 0.05) compared with group 2 and group 3. Additionally, decreased urgent operation requirement (P < 0.05) and extended preoperative drug-free interval (P < 0.001) were observed in the group 4 than those in the group 3. Preoperative optimization of CD following immunosuppressive therapy by EEN prolongs the immunosuppressants-free interval, reduces the risk of urgent surgery and reoperation, and most importantly, decreases complications after abdominal surgery.
authors: From the Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, PR China (YL, LZ, WZ, JG, WZ, LG, ZG, LC, NL, JL).
authors: Yi
authors: Y
authors: Li
authors: Lugen
authors: L
authors: Zuo
authors: Weiming
authors: W
authors: Zhu
authors: Jianfeng
authors: J
authors: Gong
authors: Wei
authors: W
authors: Zhang
authors: Lili
authors: L
authors: Gu
authors: Zhen
authors: Z
authors: Guo
authors: Lei
authors: L
authors: Cao
authors: Ning
authors: N
authors: Li
authors: Jieshou
authors: J
authors: Li
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D057234:Preoperative Period; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents
references: Aliment Pharmacol Ther. 2010 Aug;32(3):459-65
references: 20497144
references: Clin Nutr. 2014 Oct;33(5):850-8
references: 24200200
references: Gastroenterology. 1999 Sep;117(3):527-35
references: 10464128
references: Dis Colon Rectum. 2014 May;57(5):663-74
references: 24819109
references: Am Surg. 1984 Oct;50(10):546-8
references: 6486571
references: Inflamm Bowel Dis. 1999 May;5(2):119-33
references: 10338381
references: Gastroenterology. 1990 Oct;99(4):956-63
references: 2394349
references: Nutr Clin Pract. 2013 Aug;28(4):499-505
references: 23851180
references: Gut. 1989 Jul;30(7):990-5
references: 2759493
references: Ann Surg. 1978 Nov;188(5):706-9
references: 718298
references: Dis Colon Rectum. 2012 May;55(5):563-8
references: 22513435
references: Am J Surg. 1988 Jan;155(1):43-8
references: 3341537
references: Ann Surg. 2000 Jan;231(1):38-45
references: 10636100
references: Aliment Pharmacol Ther. 2004 Jul 15;20(2):167-72
references: 15233696
references: Gut. 1984 Jun;25(6):665-72
references: 6735250
references: J Gastrointest Surg. 2008 Oct;12(10):1738-44
references: 18709420
references: Am J Gastroenterol. 2004 May;99(5):878-83
references: 15128354
references: Scand J Gastroenterol. 2012 Feb;47(2):170-7
references: 22242614
references: Lancet. 2007 May 12;369(9573):1641-57
references: 17499606
references: Am J Gastroenterol. 2009 Feb;104(2):465-83; quiz 464, 484
references: 19174807
references: Gut. 2004 Jun;53(6):849-53
references: 15138212
references: Am J Surg. 1999 Sep;178(3):240-5
references: 10527447
references: J Clin Gastroenterol. 2014 Oct;48(9):790-5
references: 24440935
references: Aliment Pharmacol Ther. 2007 Nov 15;26(10):1303-12
references: 17848181
references: Surgery. 1988 Jun;103(6):648-52
references: 3131905
references: Eur J Clin Nutr. 2014 Apr;68(4):441-6
references: 24549026
references: J Clin Pharmacol. 1990 Apr;30(4):358-63
references: 2341582
references: World J Gastroenterol. 2013 Nov 21;19(43):7652-60
references: 24282355
references: Inflamm Bowel Dis. 2014 Sep;20(9):1568-74
references: 24983977
references: Am J Gastroenterol. 2013 Apr;108(4):583-93
references: 23481144
references: Br J Surg. 2013 Jul;100(8):1089-93
references: 23649458
references: Arch Surg. 1992 Oct;127(10):1210-2
references: 1417487
references: Gut. 2005 Feb;54(2):237-41
references: 15647188
references: N Engl J Med. 2002 Aug 8;347(6):417-29
references: 12167685
references: PLoS One. 2013 May 23;8(5):e63675
references: 23717464
references: Clin Colon Rectal Surg. 2007 Nov;20(4):303-8
references: 20011426
references: Dis Colon Rectum. 2000 Aug;43(8):1141-5
references: 10950014
references: J Gastroenterol Hepatol. 2006 Oct;21(10):1609-14
references: 16928225
references: Dis Colon Rectum. 1984 Jul;27(7):462-7
references: 6745018
references: Mol Nutr Food Res. 2008 Aug;52(8):875-84
references: 18711759
references: Ann Surg. 1985 Apr;201(4):494-8
references: 3977451
references: Scand J Gastroenterol. 2012 Oct;47(10):1181-91
references: 22845663