title: Specialized enteral nutrition therapy in Crohn's disease patients on maintenance infliximab therapy: a meta-analysis.
abstract: OBJECTIVE
  Many patients with Crohn's disease on infliximab maintenance therapy have recurrent symptoms despite an initial clinical response. Therefore, concomitant therapies have been studied. We conducted a meta-analysis to assess the effect of specialized enteral nutrition therapy with infliximab versus infliximab monotherapy in patients with Crohn's disease.
  
  
  METHODS
  A comprehensive search of multiple databases was performed. All studies of adult patients with Crohn's disease comparing specialized enteral nutrition therapy (elemental or polymeric diet with low-fat or regular diet) with infliximab versus infliximab monotherapy without dietary restrictions were included. Meta-analysis was performed using the Mantel-Haenszel (fixed effect) model with odds ratio (OR) to assess for clinical remission.
  
  
  RESULTS
  Four studies (n = 342) met inclusion criteria. Specialized enteral nutrition therapy with infliximab resulted in 109 of 157 (69.4%) patients reaching clinical remission compared with 84 of 185 (45.4%) with infliximab monotherapy [OR 2.73; 95% confidence interval (CI): 1.73-4.31, p < 0.01]. Similarly, 79 of 106 (74.5%) patients receiving enteral nutrition therapy and infliximab remained in clinical remission after one year compared with 62 of 126 (49.2%) patients receiving infliximab monotherapy (OR 2.93; 95% CI: 1.66-5.17, p < 0.01). No publication bias or heterogeneity was noted for either outcome.
  
  
  CONCLUSIONS
  The use of specialized enteral nutrition therapy in combination with infliximab appears to be more effective at inducing and maintaining clinical remission among patients with Crohn's disease than infliximab monotherapy.
authors.affiliation: Department of Medicine, University of California Irvine, Irvine, CA, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, Loyola University, Chicago, IL, USA.
authors.forename: Lena B
authors.initials: LB
authors.lastname: Palmer
authors.affiliation: Department of Pharmacy, University of California - Irvine, CA, USA.
authors.forename: Emily T
authors.initials: ET
authors.lastname: Nguyen
authors.affiliation: Department of Medicine, University of Louisville, Louisville, KY, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
authors.affiliation: Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.affiliation: Division of Gastroenterology & Hepatology, University of Missouri Health Sciences Center, CE405, DC 043.00, Five Hospital Drive, Columbia, MO 65212, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Bechtold
keywords: Crohn’s disease; enteral nutrition; infliximab; meta-analysis