1976, South Africa
1977, UK.The use of an elemental diet in gastro intestinal diseases
L O Tim, H S Odes, P J Duys, B H Novis, S Bank, C A Helman
An elemental diet containing predigested protein, a high content of predigested fat and carhobydrate, trace elements and vitamins, was administered as the only form of nutrition to 9 adult patients with chlonic, ileal and pancreatic fistulae, Crohn's disease, ulcerative colitis, malabsorption states and abdominal lymphoma, and to 4 children with protracted diarrhoea. The diet was administered orally through a nasogastric tube for 1 - 8 weeks. Two patients were treated on an outpatient basis. There was considrable clinical improvement in 6 adults and in 3 children. Two adults and 1 child did not respond and 1 adult did not co-operate. The results justify the use of this elemental diet in carefully selected patients under strict medical supervision.
1977, Germany.Levamisole in the treatment of Crohn's disease
A W Segal, A J Levi, G Loewi
In 8 patients with active uncomplicated Crohn's disease who were not receiving any specific therapy, a clinical remission was induced with an elemental diet, and then an attempt was made to maintain this remission with levamisole. This regimen resulted in excellent control of the disease. A drug-induced arthritis developed in two patients and resolved spontaneously. There were no other significant side-effects.
1977, FranceClinical and metabolic investigations in the acute stage of Crohn's disease using total parenteral nutrition and elemental diet
Böhles H. - Koch H. - Heid H. - Fekl W.
A 14-year-old female patient in the acute stage of Crohn's disease was treated with total parenteral nutrition (TPE) and elemental diet (ED). There was immediate improvement of the acute symptoms. With TPE, N retention of 3.2-5.6 g/day was achieved. With elemental diet, N retention was reduced, probably because the N content of the oral diet was too low. During the 7 weeks of treatment, a weight gain of 7 kg was achieved.
1980, UKThe treatment of Crohn's disease in the child. 12 cases
J Navarro, J L Fontaine, J C Mathé, J P Girardet, P Pernin, J F Mougenot, C Polonovski
Therapeutic aspects of Crohn's disease in pediatrics are discussed. New renutrition techniques are pointed out: total parenteral nutrition in 4 cases, and constant rate enteral nutrition in 6 cases (with elemental diet). In association with anti-anflammatory and anti-bacterial drugs results seemed very remarkable: in all cases, dramatic clinical recovery, and even radiologic improvement. In two cases surgery appeared to be defered after more than one year of evolution.
1982, CanadaElemental diets in treatment of acute Crohn's disease.
C O'Morain, A W Segal, and A J Levi
Twenty-seven patients with 32 acute exacerbations of Crohn's disease were treated for four weeks with an elemental diet. At the end of treatment 29 of the exacerbations had remitted both clinically and biochemically. After six months six patients had relapsed. These findings suggest that the elemental diet is effective in treating acute Crohn's disease, but the reasons are not clear. The diet may be effective because it provides nutritional support, is hypoallergenic, acts as a medical bypass from the affected area, or alters bowel flora. The patient's general wellbeing is improved by the supply of adequate energy and essential foodstuffs in a form easily available without further digestion and given in a safe, simple, non-toxic way.
1984, Germany.Continuous elemental enteral alimentation in the treatment of children and adolescents with Crohn's disease
C L Morin, M Roulet, C C Roy, A Weber, N Lapointe
Ten pediatric patients, aged 8.5-19 years, with active symptomatic Crohn's disease, received a three-week period of continuous elemental enteral alimentation with no other form of treatment. All patients in this study were selected according to the following criteria, which were applied consecutively: (1) newly diagnosed patients with no previous treatment for Crohn's disease, (2) disease activity index over 200, and (3) no complication requiring surgery. All patients experienced a clinical remission and improved their immunologic and nutritional status during the elemental enteral alimentation. The mean disease activity index for the whole group was 307.0 +/- 23.6 (range: 203 to 413) before and 69.2 +/- 11.4 (range: 15 to 114) after the feeding period. Significant increases in body weight, triceps skinfold, mid-arm circumference, serum transferrin and mean percentage of T lymphocytes were also observed. Following cessation of enteral alimentation, a small declining dose of prednisone was used during a one-year follow-up period. Eight of the ten patients were still in clinical remission three months after the feeding period and their nutritional status had continued to improve during that period of time.
Is tube feeding with elemental diets a primary therapy of Crohn's disease?
H Lochs, M Egger-Schödl, R Schuh, S Meryn, G Westphal, R Pötzi
Tube feeding (TF) with elemental diets was used as primary therapy in 25 patients with an acute phase of Crohn's disease (CD). Feed was infused continuously via a nasoduodenal tube in a dosage of 2600-3200 kcal/day. The Crohn's disease activity index (CDAI), the serum levels of a1-antitrypsin, C-reactive protein (CRP) and haptoglobin were used as parameters for disease activity; the body weight and the serum levels of albumin, prealbumin and transferrin were parameters for the nutritional status. Disease activity could be reduced in the total group by TF shown by a reduction of CDAI from 269 +/- 72 to 174 +/- 103, a1-antitrypsin from 449 +/- 160 to 378 +/- 147 mg/dl, CRP from 6.12 +/- 5.6 to 3.23 +/- 5.4 mg/dl and haptoglobin from 414 +/- 167 to 344 +/- 152 mg/dl. Nutritional status was improved (body weight 83 +/- 12% to 87 +/- 10% ideal body weight, prealbumin 20.2 +/- 7.7 to 29.7 +/- 9.5 mg/dl, and transferrin 229 +/- 107 to 310 +/- 103 mg/dl). Albumin did not change significantly. In 15 patients the CDAI was reduced to levels below 150. These patients were characterized as responders. In ten patients a normalization of CDAI could not be achieved and therapy had to be changed. With a stepwise linear discriminant analysis it could be demonstrated that patients with colonic disease and fever do not react to TF, with a probability of 90%. We conclude that TF can be used as primary therapy for the acute phase of CD in patients with small bowel disease. In patients with colonic disease and fever it is not as effective.