Pre-Operative Feeding Reduces Crohn’s Surgical Complications

A new study reports that that pre-operative optimization of patients with Crohn's disease with exclusive enteral liquid nutrition gives better post-surgical results.

Researchers at the Royal Devon and Exeter NHS Foundation Trust conducted a study involving 51 Crohn's patients requiring urgent surgery for strictures or penetrating complications, in order to test the hypothesis that exclusive enteral nutrition provides a safe and effective bridge to surgery and helps reduce post-operative complications. Overall, 13 patients were treated with exclusive enteral nutrition prior to surgery, who were each matched with two control patients for disease behavior, type of surgery, age at diagnosis, and disease duration.

The results showed that median length of surgery was half an hour shorter in the patients pre-optimized with exclusive enteral nutrition. In addition, only 3% of the patients who received liquid enteral feeding developed a post-operative abscess and/or anastomotic leak, compared with 20% in patients who went straight to surgery. Moreover, one-quarter of the patients who received liquid feeding avoided surgery completely. The study was published on January 20, 2017, in Alimentary Pharmacology & Therapeutics.

“Despite improvements in medical care, about two-thirds of patients with Crohn's disease develop complications requiring intestinal surgery at some time, and post-operative healing can be complicated,” said lead author Neel Heerasing, MD. “Exclusive enteral nutrition frequently down-stages the need for surgery in patients presenting with stricturing or penetrating complications of Crohn's disease; it is associated with a reduction in systemic inflammation, operative times, and the incidence of post-operative abscess or anastomotic leak.”

Crohn's disease is a chronic inflammatory disorder, in which the body's immune system attacks the gastrointestinal (GI) tract, possibly directed at microbial antigens. Crohn's disease may affect any part of the GI from mouth to anus, causing a wide variety of symptoms, including abdominal pain, diarrhea, vomiting, or weight loss, but may also cause complications outside the GI tract such as skin rashes and arthritis.