Mechanisms of Action of Exclusive Enteral Nutrition and Other Nutritional Therapies in Crohn’s Disease

[kiny]

https://www.mdpi.com/2072-6643/16/21/3581



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Figure 1. Proposed mechanisms of action of EEN in Crohn’s disease (CD). Transmural inflammation and stenosis in CD lead to increased mechanical stress (MS) in the inflamed tissue and the segment proximal to inflammation. Both the inflammatory process and MS may induce proinflammatory molecules (i.e., COX-2), cytokines and chemokines (i.e., IL-6, IL-8, osteopontin), and pain mediators (i.e., prostaglandin E2, nerve growth factor). CD is also associated with microbiota dysbiosis in the lumen. The altered gene expression and dysbiosis are responsible for inflammation, immune responses, barrier dysfunction, fibrosis, visceral pain, and dysmotility in CD. EEN treatment with liquid diet is found to reduce inflammation and immune responses, improve barrier function and motility, and restore microbiota composition and diversity. Recent studies found that these benefits may be due to EEN’s effect to attenuate MS and MS-dependent pro-inflammatory gene expression. Notes: EEN, exclusive enteral nutrition; CD, Crohn’s disease.

 

[kiny]

The mechanism of action of EN simply being related to its liquid form, resulting in a reduction of mechanical stress on the bowel wall, would make this treatment regime much more palatable, cheaper and easier to implement.

 

[kiny]

Anthony Segal suggested early lesions from an acute infection, like a common foodborne infection, would leave the intestine exposed to fecal content entering intissue tissue.

Rutgeerts pointed out that the fecal stream drives inflammation, and removal of this fecal stream or filtered with an ultrafiltrate, leads to healing. Direct contact between fecal effluent and tissue resulted in inflammation.

Reducing luminal mechanical stress from the fecal stream, should reduce contact between the fecal stream and the bowel wall. If all it takes is employing a liquid feed, then simple turning your diet into a liquid diet should help.

(Anthony Segal)

 

[kiny]

Most bacteria don't come near the bacterial wall, PP, or TLR, they seem to keep their distance and we have adapted to have a certain immunological tolerance towards them when they accidentally do. What differentiates pathogens is their ability to invade tissue, including adherence, pathogens will literally attach themselves to enterocytes in the intestine. I assume mechanical stress from the fecal stream can drive these pathogens into tissue. When Rutgeers used an ultrafiltrate, these bacteria would have been filtered out.

 

[Veske]

Have you actually tried this your self? As in... turning all your food into a blended mush.
This lady here seems to be doing just fine with such way of eating:

 

[Soryan]

If this is the case, it would be interesting to see the effect of (a) fasting, (b) non-EN fluid / liquid diet (e.g. bone broth/juice), compare to EEN.

Also PEN doesn’t work that well as EEN, guess the fecal stream has to be reduced to a level such that it contacts minimally with our bowel wall?

 

[my little penguin]

Not sure on non en liquid
But fasting (Tpn ) has been studied
While it rests the gut it is not as effective as een from what I remember.
They only use tpn prior to surgery for that reason