Exclusive Enteral Nutrition: An optimal care pathway for use in adult patients with active Crohn’s disease

Day, A.1, Wood, J.2, Melton, S.2, Purcell, L.3, O’Connor, J.4, Mutsekwa, R.5, Holt, D.6, Dunning, A.7, Bidgood, E.8, Asrani, V.9, Simpson, E.10, Burgell, R.11, Bryant, R.1

1Dept of Gastroenterology, The Queen Elizabeth Hospital, CALHN, SA Health, 2Nutrition & Dietetics, Alfred Health, Victoria, 3Dept of Nutrition & Dietetics, Logan Hospital, Queensland, 4Dept of Nutrition & Dietetics, Eastern Health, Victoria, 5Dept of Nutrition & Dietetics, Gold Coast Hospital, Queensland, 6Dept of Gastroenterology, Monash Health, Victoria, 7Nutrition and Dietetics, Liverpool Hospital, New South Wales, 8Dept of Dietetics, Royal Melbourne Hospital, Victoria, 9Dept of Nutrition & Dietetics, Auckland City Hospital, New Zealand, 10Royal Adelaide Hospital, CALHN, SA Health, 11Dept of Gastroenterology, Alfred Health, Victoria

 

Background and aim: Exclusive enteral nutrition (EEN) is emerging as a therapeutic option for adults with active Crohn’s Disease (CD). However there is no standardised approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care to benchmark practice and provide direction for future research.

Methods: A working group of 12 multidisciplinary inflammatory bowel disease specialists across Australia and New Zealand was convened to develop a practical, clinically-focused care pathway for using EEN in adults with active CD. Six key areas were identified; clinical indications, nutrition assessment, EEN protocol and monitoring, accessing formula and food re-introduction. Current literature was identified via systematic review. Quality of evidence was graded. Consensus expert opinion was provided where literature gaps were identified.

Results: An optimal care pathway and toolkit guiding clinicians to use EEN in adults with active CD was developed (Figure 1.). Six key consensus statements outline a practical therapeutic approach. These key statements identify clinical indications for use, nutrition assessment and prescription, duration of therapy, monitoring criteria, food re-introduction, and the role of partial EEN. An accompanying patient resource was also developed.

Conclusion: EEN is recommended as a treatment option for inducing remission in adults with active CD. The optimal care pathway, toolkit, and patient resource are designed as standalone resources or to be used to advocate for site-specific protocols to support standardised approach to delivering EEN therapy.


Alice Day

Alice is a Senior Research Dietitian at The Queen Elizabeth Hospital and PhD Candidate at The University of Adelaide. Alice completed her Dietetics degree with first class honours in the UK before returning to Adelaide in 2009 to continue working as a clinical dietitian predominantly within gastroenterology, surgical, and critical care services. Alice’s interest in gut nutrition research started with an honours project investigating the nutritional impact of nocturnal fasting in chronic liver disease and continued to develop through her work with patients.  Alice is currently undertaking PhD in diet and inflammatory bowel disease and is the primary investigator on a pilot dietary intervention study for people with ulcerative colitis, in collaboration with SA Health IBD Services and Monash University in Victoria. Alice is an active member of SA Gastroenterology Dietitians Network, Dietitians Crohns and Colitis Network Australia, and Australasian Society of Parenteral and Enteral Nutrition.

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