频繁的饮食干预可提高成人克罗恩病患者的依从性和临床结果

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open Pub Date : 2025-07-03 DOI:10.1002/jgh3.70207

Matthew K. W. Chu, Alice S. Day, Damjana Bogatic, Martine Hatzi, Samuel K. S. Chu, Samuel P. Costello, Robert V. Bryant

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引用次数: 0

摘要

背景和目的：成人独家肠内营养（EEN）的使用受到缺乏明确方案、依从性差和缺乏疗效的限制。本研究评估了成人克罗恩病（CD）的EEN治疗，以确定临床疗效、依从性和治疗完成的决定因素。方法：本回顾性多中心研究纳入了2019年2月1日至2022年2月28日在两所三级教学医院连续使用EEN治疗CD的成人（≥18岁）。主要结局为临床缓解（Harvey Bradshaw指数(HBI)≤4）或缓解（HBI降低≥3）。测量治疗完成度和依从性。进行意向治疗和方案分析。结果共纳入108例患者；女性54例（50.0%）。平均年龄41.8±16.1岁。47.2%（51/108）存在回肠结肠疾病，40.7%（44/108）存在狭窄表型。基线HBI为8 (IQR 6-11)；60.2%（65/108）接受了晚期治疗。在接受缓解诱导治疗的80例患者中，缓解率和缓解率分别为50.0%（40/80）和48.8%（39/80）。成活率为69.4%（75/108）。67.6%（73/108）的患者完全坚持饮食。在多变量分析中，饮食回顾的频率与治疗完成度相关（优势比（OR） 2.26, 95%可信区间（CI） 1.51-3.39, p < 0.001）。积极吸烟（OR 0.11, 95% CI 0.02-0.83, p = 0.032）降低了缓解的几率，而早期缓解（OR 17.56, 95% CI 3.18-96.84, p = 0.001）和早期反应（OR 4.94, 95% CI 1.09-22.43, p = 0.039）是治疗结束时临床缓解的预测因子。结论：早期评估和频繁的饮食随访可改善成年乳糜泻患者EEN的依从性、完成度和结局。

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Frequent Dietetic Involvement Enhances Adherence and Clinical Outcomes of Exclusive Enteral Nutrition in Adults With Crohn's Disease

Background and Aim

Use of Exclusive Enteral Nutrition (EEN) in adults has been limited by lack of defined protocols, poor adherence and perceived lack of efficacy. This study evaluated EEN therapy in adults with Crohn's disease (CD) to identify determinants of clinical efficacy, adherence, and therapy completion.

Methods

This retrospective, multicenter study included consecutive adults (≥ 18 years old) prescribed EEN for CD between February 1, 2019, and February 28, 2022, at two tertiary teaching hospitals. The primary outcome was clinical remission (Harvey Bradshaw Index (HBI) ≤ 4) or response (HBI reduction ≥ 3). Therapy completion and adherence were measured. Intention-to-treat and per-protocol analyses were performed.

Results

One-hundred-and-eight patients were included; 54 (50.0%) were female. Mean age was 41.8 ± 16.1 years. Ileocolonic disease was present in 47.2% (51/108), and 40.7% (44/108) had stricturing phenotype. Baseline HBI was 8 (IQR 6–11); 60.2% (65/108) received advanced therapies. Among 80 patients treated for remission induction, remission and response rates were 50.0% (40/80) and 48.8% (39/80), respectively. Completion rate was 69.4% (75/108). Complete diet adherence was observed in 67.6% (73/108). On multivariable analysis, frequency of dietetic review was associated with therapy completion (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.51–3.39, p < 0.001). Active smoking (OR 0.11, 95% CI 0.02–0.83, p = 0.032) reduced odds of remission, whereas early remission (OR 17.56, 95% CI 3.18–96.84, p = 0.001) and early response (OR 4.94, 95% CI 1.09–22.43, p = 0.039) were predictors of clinical remission at end-of-therapy.