title: Enteral Feeding Therapy for Maintaining Remission in Crohn's Disease: A Systematic Review.
abstract: The efficacy of enteral nutrition (EN) for maintaining remission in patients with inactive Crohn's disease (CD) is unclear. The aim of this article was to systematically identify, review, and critically appraise the evidence on efficacy of EN in maintaining medically induced remission in CD.
  
  
  
  Several databases were searched from inception to April 2015 for relevant citations of published randomized controlled trials and nonrandomized cohort studies. Two reviewers independently selected studies for inclusion and assessed study quality and risk of bias. The primary outcome was relapse rate in patients with inactive CD who have been in medically induced remission and subsequently started or maintained on EN.
  
  
  
  Twelve studies (1169 patients, including 95 children) fulfilled the inclusion criteria. As the included studies were significantly heterogeneous, a meta-analysis was not performed. Eleven studies showed that EN was either better than, or as effective as, the comparator in maintaining remission in patients with inactive CD. No major EN-related adverse events were reported. Only 1 adult randomized controlled trial (n = 51), with low risk of bias, compared EN with regular diet and found a relapse rate of 34% in the EN group versus 64% in the control group ( P < .01) after a mean follow-up of 11.9 months.
  
  
  
  EN is more effective than regular diet and as effective as some medications in maintaining remission for patients with inactive CD. Large, properly designed randomized controlled studies of sufficient duration are required to confirm this conclusion for EN versus individual medications.
authors.affiliation: 1 Section of Pediatric Gastroenterology and Children's Hospital Research Institute of Manitoba, Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: Wael
authors.initials: W
authors.lastname: El-Matary
authors.affiliation: 2 Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Otley
authors.affiliation: 3 Department of Pediatrics, Memorial University, St John's, Newfoundland, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Critch
authors.affiliation: 4 George and Fay Yee Center for Healthcare Innovation, College of Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Setta
mesh_terms: D003424:Crohn Disease / Q000628:therapy*; D004750:Enteral Nutrition; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction
keywords: Crohn’s disease; colitis; enteral nutrition; inflammatory bowel disease