Understanding Patient and Physician Perspectives on Exclusive Enteral Nutrition in Adults with Crohn's Disease: Bridging the Gap in Nutritional Therapy.

Abstract

Background and Aims: Exclusive enteral nutrition (EEN) effectively induces remission in pediatric Crohn's disease (CD), but reasons for its limited use in adults remain unclear. This study aimed to identify and compare patients' and physicians' perspectives on barriers to EEN use, in order to inform strategies to enhance its utilization. Methods: An online questionnaire was distributed to adult CD patients and gastroenterologists, collecting data on demographics, disease characteristics, previous EEN exposure, and attitudes toward EEN and potential barriers (Likert scale 1-5). Comparative analysis and logistic regression identified factors associated with reluctance toward EEN. Results: A total of 315 CD patients (mean age 36.7) and 42 physicians completed the survey. Previous EEN use was reported by 40%, while 20.3% of the entire cohort were reluctant to use it. The only factor that predicted reluctance was current use of advanced therapy (OR 2.06 [95%CI 1.05-4.35]). Among physicians, 71% had prescribed EEN, and 81% were willing to do so. Key barriers were lack of food variety (65% Likert score > 3) and reduced social interaction (59%) among patients and social interaction (67.3%) and taste concerns (54.7%) among physicians. Patients rated hunger sensation and lack of food variety concerns as more significant barriers than physicians. Patients identified direct communication with staff (68.6% Likert score > 3) and full cost coverage (65%) as facilitators for adherence. Notably, 87% wanted more information from their doctors. Conclusions: Most adult CD patients and physicians are open to discuss EEN. Removing barriers related to palatability and diversity of enteral nutrition, as well as shortening of EEN duration, may enhance acceptance of and adherence to EEN.