New insights in nutritional therapy in inflammatory bowel disease

Although meta-analyses have raised serious doubts about the primary therapeutic role of enteral nutrition in Crohn's disease, detailed study of these meta-analyses indicates that, as a whole, enteral nutrition is therapeutically effective in 60% of patients with active Crohn's disease. This figure is three times higher than that reported with placebo and as high as that obtained by various drugs used as alternative therapies to glucocorticoids. Moreover, analysis of the different types of enteral formulas used in the published trials strongly suggest that some of them would be particularly effective in this condition. The amount and quality of the lipid component of these formulas seems to be of utmost importance in inducing clinical remission in these patients. Furthermore, nutrition and nutritional deficits are increasingly incriminated in the pathogenesis of Crohn's disease and ulcerative colitis. In this sense, the potential role of some nutritional deficits (e.g. micronutrients) or defective nutrient metabolism (decreased butyrate utilization in the bowel) are discussed. Although studies aimed at identifying the nutrient(s) responsible for the therapeutic effect of enteral diets in Crohn's disease are still required, it is time to consider seriously the use of nutritional approaches as steroid sparing treatment in these patients. © 2001 Harcourt Publishers Ltd.