Exclusive Enteral Nutrition (EEN) and Surgery Azar B-Nejad Senior - PowerPoint PPT Presentation

Exclusive Enteral Nutrition (EEN) and Surgery Azar B-Nejad Senior Dietitian - Gastroenterology, Colorectal Surgery and Intestinal Failure Fiona Stanley Hospital

Contents • What is EEN? • Who can benefit from EEN? • When should EEN be used? • Why should EEN be used? • How does EEN work? • What does this mean for my other treatments and medications? • A note on “other” diets

What is EEN? The provision of 100% of a persons nutrition requirements from a liquid nutrition formula Can be drank orally or if taste not tolerated, given via a feeding tube. The idea is to use as a form of therapy to induce remission

What is EEN? C’td  Drink only nutrition supplements and water for 6-8 weeks  A Dietitian will calculate the type and number of nutrition supplements you need to have per day  Can include up to 500ml of clear broth or jelly (not diet). Boiled lollies or chewing gum (not sugar free). No other food or fluids other than water  Food reintroduction must be done slowly and under the supervision of a dietitian. Food reintroduction typically takes 5-10 days  Most common reasons people refuse EEN are because they are unwilling to give up food for 6-8 weeks and taste preference

Who can benefit from EEN? People with crohns disease Children and adults People that have been recommended to trial EEN by their gastroenterologist and are under the supervision of a dietitian No evidence for its use in Ulcerative colitis (UC)

When is EEN used? • Active disease • Not usually first line therapy in adults • Help to achieve appropriate weight and BMI • Pre-operative optimisation • Obstructive symptoms • Strictures • Fistulas • Malnutrition

Why is EEN used? • Waist circumference is better linked to outcomes in IBD than BMI • Surgical risks associated with BMI too high or too low • Optimises CRP levels and to some extent Albumin i.e. reduces inflammation • Eliminates the need for steroids • Promotes mucosal healing

Why is EEN used? C’td • Cheap • Tolerable in most people with dietitian support • Reduces post-operative: - anastomotic leaks - intra abdominal abscess/collections - wound infection and dehiscence - high output stoma - recurrence of disease 6 months post op Heerasing et al., (2017). Aliment Pharmacol Ther45: 660-669

Preoperative optimisation. 35 optimised Vs 32 non-optimised patients

How does EEN work? Promotes reduced inflammation and healing of the muscosa by altering the microbiota Mucosa = The innermost layer of the GI tract It comes into contact with digested food

How does EEN work? Microbiota or “GUT flora” = t he microbe or bacterium population living in our intestine. • There are 10 billion bacterium cells per tspn of stools. • We have 10 times more bacterium in our GUT than total human body cells Changing the microbiota with EEN causes: o Reduced intestinal permeability o Enhances the GUTs barrier defence o Promotes a reduction in pro-inflammatory proteins

What does this mean for other treatments and medications? • Often if you are on any steroids, these will be reduced and stopped • EEN does not replace other maintenance medications or medical follow up. • Often used in conjunction with other medications

A note on “other” diets Doing a “liquid diet” or “juice diet” does NOT achieve the same results and often causes harm Partial EN with a crohns disease exclusion diet • 47 patients (34 children and 13 adults) • Follow up of 12 weeks • 70.6% of patients achieved remission at 6 weeks (69% of adults and 70.5% of children) • CRP normalised for 70% of patients

Crohns disease exclusion diet

Thank you Questions???