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EEN worked first time but doesn't seem to be working now

I did exclusive enteral nutrition for 6 weeks about 2 months ago. It brought my CRP into normal levels after being in the 50s and got rid of my arthritis swelling and pain as well. Unfortunately when I added foods back in, I got symptoms back right away. I tried to go back to EEN for a couple weeks but then it didn't work. My CRP shot back up the the 50s and my arthritis came back. (I've been on Imuran this whole time).

So I unfortunately had to go back on prednisone, which hasn't done anything for my gut but at least has kept the arthritis in check. I've tried another round of EEN, and I don't seem to be seeing any improvements at all when last time I saw improvements right away.

Does anyone know why it would work at first and then not again even when it's just been in a few months span?

fuzzy butterfly

Well-known member
Hi I am not sure why, have you spoken to your doctor. It may be that you have a more severe flare. Have you tried to check out the een thread on here? There are a lot of people who are doing een, who will be able to help. Best wishes 💕just realized how old this post is a oh well :ybiggrin:
EEN has been shown in some studies to lose effectiveness after its initial use.

I'm going to tag crohnsinct and my little penguin one of them it seems had the study or article that stated there was a loss of effectiveness after the first time.

my little penguin

Staff member
Two things EEN is sometimes not as effective the second time
Secondly arthritis can flare independent of Gi flares which means EEN will not stop an arthritis flare .

BACKGROUND: Exclusive enteral nutrition (EEN) induces remission and mucosal healing in children with active Crohn's disease (CD).

AIM: To compare short- and long-term outcomes of the first vs. second courses of EEN, and to identify predictors of sustained remission.

METHODS: Retrospective single centre analysis of all patients with CD (6-18 years) treated with EEN over 7.5 years. Patients were excluded if exposed to anti-TNFα or corticosteroids 3 months prior to EEN. Data included disease phenotype, activity, NOD2 genotype, laboratory indices and anthropometrics. remission and relapse were defined by mathematically weighted Paediatric Crohn's Disease Activity Index (wPCDAI) with 1-year follow-up.

RESULTS: Of 94 patients treated with EEN, 52 fulfilled inclusion criteria (31 male, mean age 13.2 years). Azathioprine was started within the first month in 33/52 patients; 26/52 received a second EEN course. First compared to second EEN revealed higher wPCDAI at start (59 vs. 40, P < 0.0001), tended to higher remission rates after 3 months (92% vs. 77%, n.s.), but showed comparable 1-year relapse rates (67% vs. 70%, median time 231 vs. 145 days, n.s.). Disease activity, weight gain and inflammatory markers showed better improvement with first EEN. Faecal calprotectin >200 μg/g during EEN was associated with shorter remission (median time 157 vs. 287 days, n.s.). Certain NOD2 genotypes were related to higher relapse rates (92% R702W or G908R vs. 50% 1007fs vs. 60% wild-type, P < 0.01).

CONCLUSIONS: Exclusive enteral nutrition induces remission in active Crohn's disease, but efficacy tends to decrease with the second course. Despite early azathioprine use, 1-year relapse rates are high, but may be related to NOD2 genotype.

Repeated exclusive enteral nutrition in the treatment of paediatric Crohn's disease: predictors of efficacy and outcome.
Frivolt K, et al. Aliment Pharmacol Ther. 2014.
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