PEN (Partial Enteral Nutrition) does not reduce inflammation and is not an effective treatment for active Crohn’s Disease.
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kiny
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PEN does not reduce inflammation and is ineffective.
Several robust studies have pointed this out, few actually get featured by media outlets.
The few PEN studies that are featured, are generally underpowered, often feature additional medication or consider weight gain or general well being as a positive response to PEN, irrespective of non-response to inflammation.
There have been a few "questionable" pediatric studies from an Israeli team claiming CDED + PEN is effective. The main author of these studies has been jailed for patient abuse, so there have been no follow up studies afaik. Still, these studies are underpowered and I am quite critical of them.
As the authors (of this study) point out, it is unlikely to be EN itself, or its dosage, that reduces inflammation, elemental and polymeric formulas are equally effective, TGF-β rich formulas do not seem to do better nor worse. While there is still some discussion regarding fat content, 1 study showed that the amount of fat in formulas is irrelevant, another suggested the fat profile was relevant, but a second more robust study trying to recreate this conclusion saw no difference in remission rates in formulas with different chain lengths of the fatty acids.
What is likely is that EN works through the exclusion of normal foods.
Diets have been proven to be quite ineffective in crohn's disease, the sole exception has been the total exclusion of normal foods though EN.
Rutgeerts pointed to the fecal stream as the initiator of inflammation.
"There are two possible explanations for the absence of an
anti-inflammatory effect with PEN. It could be attributed to a
simple ‘‘dose effect’’. By reducing the total amount of liquid
formula the biological effect on the inflammatory process
might have been reduced. Alternatively, the anti-inflamma-
tory effect might have been lost due to the continued intake
of normal foods. This latter explanation appears more
probable. The absence of any significant improvement in
blood indices with PEN argues against a ‘‘dose effect’’
phenomenon.
Adherence to TEN is often difficult, and the treatment may
have significant psychosocial consequences for both child
and family. While most children accept TEN at first
presentation, some may be reluctant to receive repeated
courses of treatment when relapses occur, and most
eventually receive corticosteroid therapy. PEN would be more
acceptable than TEN, but this study shows it is not an
effective treatment for active Crohn’s disease. Moreover,
given that PEN does not suppress inflammation it is unlikely
that it can truly prevent disease relapse.
Several robust studies have pointed this out, few actually get featured by media outlets.
The few PEN studies that are featured, are generally underpowered, often feature additional medication or consider weight gain or general well being as a positive response to PEN, irrespective of non-response to inflammation.
There have been a few "questionable" pediatric studies from an Israeli team claiming CDED + PEN is effective. The main author of these studies has been jailed for patient abuse, so there have been no follow up studies afaik. Still, these studies are underpowered and I am quite critical of them.
As the authors (of this study) point out, it is unlikely to be EN itself, or its dosage, that reduces inflammation, elemental and polymeric formulas are equally effective, TGF-β rich formulas do not seem to do better nor worse. While there is still some discussion regarding fat content, 1 study showed that the amount of fat in formulas is irrelevant, another suggested the fat profile was relevant, but a second more robust study trying to recreate this conclusion saw no difference in remission rates in formulas with different chain lengths of the fatty acids.
What is likely is that EN works through the exclusion of normal foods.
Diets have been proven to be quite ineffective in crohn's disease, the sole exception has been the total exclusion of normal foods though EN.
Rutgeerts pointed to the fecal stream as the initiator of inflammation.
"There are two possible explanations for the absence of an
anti-inflammatory effect with PEN. It could be attributed to a
simple ‘‘dose effect’’. By reducing the total amount of liquid
formula the biological effect on the inflammatory process
might have been reduced. Alternatively, the anti-inflamma-
tory effect might have been lost due to the continued intake
of normal foods. This latter explanation appears more
probable. The absence of any significant improvement in
blood indices with PEN argues against a ‘‘dose effect’’
phenomenon.
Adherence to TEN is often difficult, and the treatment may
have significant psychosocial consequences for both child
and family. While most children accept TEN at first
presentation, some may be reluctant to receive repeated
courses of treatment when relapses occur, and most
eventually receive corticosteroid therapy. PEN would be more
acceptable than TEN, but this study shows it is not an
effective treatment for active Crohn’s disease. Moreover,
given that PEN does not suppress inflammation it is unlikely
that it can truly prevent disease relapse.
Last edited:
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