Reduction faecal calprotectin during EN is lost rapidly after food re‐introduction

[kiny]

-EN shows largest decrease in calprotectin at 4 weeks
-EN continues to decrease calprotectin at 8 weeks but at a slower rate

-Results show EN effectiveness might be dose-dependent (a similar study in Japan also suggested this)

-discontinuation of EN increases calprotectin within 17 days
-inflammation fully returns to pre-EN levels 52 days after discontinuation of EN

-low dose of maintenance EN is unable to prevent the return of inflammation

 

[kiny]

The most important question we need an answer to.

Why does inflammation return.

A) due to the cessation of EN at 8 weeks

B) due to the reintroduction of food at 8 weeks

If A, then there is an active component in EN responsible for the decrease in inflammation, likely one that is dose-dependent, and we need to find out what it is.

 

[kiny]

Elental (popular Japanese EN) was used as EN in Chinese adults with CD. EN seems just as effective as in adults as in pediatrics.

Largest drops in inflammation happened at week 4.

Clinical response in 18/19 patients at week four, and all 19/19 patients at week 8.

Full endoscopic remission in 52% of patients at week 12.

It's not mentioned in the absctract, but 4 out of 7 patients with fistula had fistula closure at week 12, and the 3 other patient had improvements in fistula.×1754 39,1

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[asadmom]

I am definitely amazed at the good effects of EEN. I wonder if the low-residue diet can potential treat other problems? We know now that our gut is important and many problems (not just IBD) can trace their origins to the gut, I wonder if EEN is a good thing to just do every now and then for non-IBD population.

 

[kiny]

EN use decreases bacterial load and decreases the diversity of the intestinal microbiome.

EN, completely lacking in fiber, goes against the idea commonly found in media outlets, that a diverse microbiome is protective against disease and that fiber rich diets should be encouraged.

Bacterial overgrowth in the small intestinal is finally been appreciated (SIBO). EN is very effective at treating SIBO.

It will take a long time before it is recognized that many animals do not feature resident microbiomes, have transient microbiomes, and seem to lack many of the intestinal diseases other species suffer from.

 

[asadmom]

EN use decreases bacterial load and decreases the diversity of the intestinal microbiome.

EN, completely lacking in fiber, goes against the idea commonly found in media outlets, that a diverse microbiome is protective against disease and that fiber rich diets should be encouraged.

Bacterial overgrowth in the small intestinal is finally been appreciated (SIBO). EN is very effective at treating SIBO.

It will take a long time before it is recognized that many animals do not feature resident microbiomes, have transient microbiomes, and seem to lack many of the intestinal diseases other species suffer from.

Many times when we visit the hospitals (non-serious, not IBD related) the doctors would ask us to change the diet or manage stress etc... I just wonder if a short course EEN is also suggested if the patient could avoid many medications if the bacteria load could be lowered first? Like doing a fast

Since EEN is full of sugar I also wonder if sugar is really not our guts enemy but sugar that hangs out in the gut is?

 

[asadmom]

Oh I have one more question. When using EEN to treat SIBO, does the patient need to be medicated after EEN? Because that's what we do with Crohn's. After a short course of EEN we need to switch to a pharmaceutical product or else Crohn's comes back immediately after food is introduced.

 

[kiny]

Since EEN is full of sugar I also wonder if sugar is really not our guts enemy but sugar that hangs out in the gut is?

Well EN specifically uses glucose syrup made with hydrolysis of starch (it doesn't have anyhting to do with starches after hydrolysis). These glucose syrups are taken up very quickly. EN lacks disaccharide and starch, you don't have undigested carbohydrates left in the intestine that would fuel the expansion of pathogens.

Oh I have one more question. When using EEN to treat SIBO, does the patient need to be medicated after EEN?

After SIBO has been resolved, they just need to be mindful to consume a bioavailable diet that avoids bacterial overgrowth, like avoiding FODMAP.

 

[kiny]

EN use decreases bacterial load and decreases the diversity of the intestinal microbiome.