Year 2017 / Volume 109 / Number 12
Original
Enteral nutrition is associated with a decreased risk of surgical intervention in Crohn’s disease patients with spontaneous intra-abdominal abscess

834-842

DOI: 10.17235/reed.2017.5116/2017

Xiao-Bin Zheng, Xiang Peng, Xiao-Yu Xie, Lei Lian, Xian-Rui Wu, Jian-Cong Hu, Xiao-Wen He, Jia Ke, Yu-Feng Chen, Min Zhi, Xiao-Jian Wu, Xiao-Sheng He, Ping Lan,

Abstract
Background: The impact of enteral nutrition (EN) on surgical risk in Crohn’s disease (CD) patients suffering from spontaneous intra-abdominal abscess (IAA) was evaluated. Methods: CD patients diagnosed with spontaneous IAA from 2008 to 2015 were included in the study. The impact of EN on surgical risk was evaluated using both univariate and multivariate analyses. Results: A total of 87 patients were enrolled, 66 (75.9%) were male. The mean age at the development of an abscess was 30.2 ± 10.1 years and the median duration of illness from CD diagnosis until the development of an abscess was three (2-6) years. After a median follow-up of 1.9 (1.1-2.9) years, surgical intervention was performed in 42 patients (48.3%). Patients treated with EN were less likely to require surgical intervention (26.1% vs 56.3%, p = 0.01). Multivariate analysis showed that EN was an independent protective factor for the risk of surgery with a hazard ratio of 0.27 (95% confidence interval: 0.11-0.65, p = 0.004) after adjusting for abdominal pain, history of abdominal surgery, concomitant intestinal stenosis and prior use of antibiotics within three months. Conclusions: Surgical intervention is common for CD patients with IAA. Appropriate application of EN may help obviate the need for surgical treatment.
Share Button
New comment
Comments
No comments for this article
References
1. Yamaguchi A, Matsui T, Sakurai T, et al. The clinical characteristics and outcome of intraabdominal abscess in Crohn's disease. J Gastroenterol. 2004;39:441-448.
2. Richards RJ. Management of abdominal and pelvic abscess in Crohn's disease. World J Gastrointest Endosc. 2011;3:209-212.
3. He X, Lin X, Lian L, et al. Preoperative Percutaneous Drainage of Spontaneous Intra-Abdominal Abscess in Patients With Crohn's Disease: A Meta-Analysis. J Clin Gastroenterol. 2015;49:e82-90.
4. Fleshman JW. Pyogenic complications of Crohn's disease, evaluation, and management. J Gastrointest Surg. 2008;12:2160-2163.
5. Nakahigashi M, Yamamoto T, Sacco R, et al. Enteral nutrition for maintaining remission in patients with quiescent Crohn's disease: current status and future perspectives. Int J Colorectal Dis. 2016;31:1-7.
6. Zhao J, Dong JN, Gong JF, et al. Impact of enteral nutrition on energy metabolism in patients with Crohn's disease. World J Gastroenterol. 2015;21:1299-1304.
7. Li Y, Zuo L, Zhu W, et al. Role of exclusive enteral nutrition in the preoperative optimization of patients with Crohn's disease following immunosuppressive therapy. Medicine (Baltimore). 2015;94:e478.
8. Konno M, Takahashi M, Toita N, et al. Long-term therapeutic effectiveness of maintenance enteral nutrition for Crohn's disease. Pediatr Int. 2015;57:276-280.
9. Clancy C, Boland T, Deasy J, et al. A Meta-analysis of Percutaneous Drainage Versus Surgery as the Initial Treatment of Crohn's Disease-related Intra-abdominal Abscess. J Crohns Colitis. 2016;10:202-208.
10. Liu S, Ren J, Gu G, et al. Comparative outcomes of trocar puncture with sump drain, percutaneous drainage, and surgical drainage in the management of intra-abdominal abscesses in Crohn's disease. Surg Innov. 2014;21:580-589.
11. Xie Y, Zhu W, Li N, et al. The outcome of initial percutaneous drainage versus surgical drainage for intra-abdominal abscesses in Crohn's disease. Int J Colorectal Dis. 2012;27:199-206.
12. Nguyen DL, Sandborn WJ, Loftus EV, Jr., et al. Similar outcomes of surgical and medical treatment of intra-abdominal abscesses in patients with Crohn's disease. Clin Gastroenterol Hepatol. 2012;10:400-404.
13. Garcia JC, Persky SE, Bonis PA, et al. Abscesses in Crohn's disease: outcome of medical versus surgical treatment. J Clin Gastroenterol. 2001;32:409-412.
14. Nguyen DL, Nguyen ET, Bechtold ML. Outcomes of initial medical compared with surgical strategies in the management of intra-abdominal abscesses in patients with Crohn's disease: a meta-analysis. Eur J Gastroenterol Hepatol. 2015;27:235-241.
15. Kim DH, Cheon JH, Moon CM, et al. [Clinical efficacy of nonsurgical treatment of Crohn's disease-related intraabdominal abscess]. Korean J Gastroenterol. 2009;53:29-35.
16. Leppaniemi A, Kimball EJ, De Laet I, et al. Management of abdominal sepsis--a paradigm shift? Anaesthesiol Intensive Ther. 2015;47:400-408.
17. Lodewijkx PJ, Besselink MG, Witteman BJ, et al. Nutrition in acute pancreatitis: a critical review. Expert Rev Gastroenterol Hepatol. 2016;10:571-580.
18. Dupont B, Musikas M, Dao MT, et al. Timing and Route of Enteral Nutrition in Severe Acute Pancreatitis? Pancreas. 2016;45:e20.
19. Triantafillidis JK, Vagianos C, Papalois AE. The role of enteral nutrition in patients with inflammatory bowel disease: current aspects. Biomed Res Int. 2015;2015:197167.
20. Altomare R, Damiano G, Abruzzo A, et al. Enteral nutrition support to treat malnutrition in inflammatory bowel disease. Nutrients. 2015;7:2125-2133.
21. P OC, Begun J, Keely S, et al. Towards an integrated understanding of the therapeutic utility of exclusive enteral nutrition in the treatment of Crohn's disease. Food Funct. 2016;7:1741-1751.
22. Nahidi L, Day AS, Lemberg DA, et al. Paediatric inflammatory bowel disease: a mechanistic approach to investigate exclusive enteral nutrition treatment. Scientifica (Cairo). 2014;2014:423817.
23. Schwerd T, Frivolt K, Clavel T, et al. Exclusive enteral nutrition in active pediatric Crohn disease: Effects on intestinal microbiota and immune regulation. J Allergy Clin Immunol. 2016;138:592-596.
24. Kang Y, Kim S, Kim SY, et al. Effect of short-term partial enteral nutrition on the treatment of younger patients with severe Crohn's disease. Gut Liver. 2015;9:87-93.
25. Kaakoush NO, Day AS, Leach ST, et al. Effect of exclusive enteral nutrition on the microbiota of children with newly diagnosed Crohn's disease. Clin Transl Gastroenterol. 2015;6:e71.
26. Lomer MC, Gourgey R, Whelan K. Current practice in relation to nutritional assessment and dietary management of enteral nutrition in adults with Crohn's disease. J Hum Nutr Diet. 2014;27 Suppl 2:28-35.
27. Soo J, Malik BA, Turner JM, et al. Use of exclusive enteral nutrition is just as effective as corticosteroids in newly diagnosed pediatric Crohn's disease. Dig Dis Sci. 2013;58:3584-3591.
28. Levine A, Wine E. Effects of enteral nutrition on Crohn's disease: clues to the impact of diet on disease pathogenesis. Inflamm Bowel Dis. 2013;19:1322-1329.
29. Tjellstrom B, Hogberg L, Stenhammar L, et al. Effect of exclusive enteral nutrition on gut microflora function in children with Crohn's disease. Scand J Gastroenterol. 2012;47:1454-1459.
30. Yamamoto T, Nakahigashi M, Umegae S, et al. Enteral nutrition for the maintenance of remission in Crohn's disease: a systematic review. Eur J Gastroenterol Hepatol. 2010;22:1-8.
31. Csontos ÁA, Molnár A, Piri Z et al. Malnutrition risk questionnaire combined with body composition measurement in malnutrition screening in inflammatory bowel disease. Rev Esp Enferm Dig. 2017;109(1):26-32.
32. Van Limbergen J, Haskett J, Griffiths AM, et al. Toward enteral nutrition for the treatment of pediatric Crohn disease in Canada: a workshop to identify barriers and enablers. Can J Gastroenterol Hepatol. 2015;29:351-356.
33. Wang H, Zuo L, Zhao J, et al. Impact of Preoperative Exclusive Enteral Nutrition on Postoperative Complications and Recurrence After Bowel Resection in Patients with Active Crohn's Disease. World J Surg. 2016;40:1993-2000.
34. Li G, Ren J, Wang G, et al. Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn's disease. Eur J Clin Nutr. 2014;68:441-446.
35. Yamamoto T, Shiraki M, Nakahigashi M, et al. Enteral nutrition to suppress postoperative Crohn's disease recurrence: a five-year prospective cohort study. Int J Colorectal Dis. 2013;28:335-340.
36. Ananthakrishnan AN, McGinley EL. Treatment of intra-abdominal abscesses in Crohn's disease: a nationwide analysis of patterns and outcomes of care. Dig Dis Sci. 2013;58:2013-2018.
37. Edelblum KL, Turner JR. The tight junction in inflammatory disease: communication breakdown. Curr Opin Pharmacol. 2009;9:715-720.
38. Laukoetter MG, Nava P, Nusrat A. Role of the intestinal barrier in inflammatory bowel disease. World J Gastroenterol. 2008;14:401-407.
39. Du L, Kim JJ, Shen J, et al. Crosstalk between Inflammation and ROCK/MLCK Signaling Pathways in Gastrointestinal Disorders with Intestinal Hyperpermeability. Gastroenterol Res Pract. 2016;2016:7374197.
40. Gerasimidis K, Bertz M, Hanske L, et al. Decline in presumptively protective gut bacterial species and metabolites are paradoxically associated with disease improvement in pediatric Crohn's disease during enteral nutrition. Inflamm Bowel Dis. 2014;20:861-871.
41. Shah R, Kellermayer R. Microbiome associations of therapeutic enteral nutrition. Nutrients. 2014;6:5298-5311.
42. Wu G. Dietary requirements of synthesizable amino acids by animals: a paradigm shift in protein nutrition. J Anim Sci Biotechnol. 2014;5:34.
43. Marion-Letellier R, Raman M, Savoye G, et al. Nutrient modulation of autophagy: implications for inflammatory bowel diseases. Inflamm Bowel Dis. 2013;19:205-212.
44. Chen R, Zou Y, Mao D, et al. The general amino acid control pathway regulates mTOR and autophagy during serum/glutamine starvation. J Cell Biol. 2014;206:173-182.
45. Hu D, Ren J, Wang G, et al. Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in Crohn's disease. J Clin Gastroenterol. 2014;48:790-795.
46. Burch JM, Ortiz VB, Richardson RJ, et al. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215:476-483.
Related articles

Letter

Treatment with hyperbaric oxygen in a Crohn’s disease patient

DOI: 10.17235/reed.2024.10166/2023

Letter

Lung abscess in a non-compliant patient with Crohn’s disease

DOI: 10.17235/reed.2024.10140/2023

Letter

Coincidental oral lesions in Crohn’s disease

DOI: 10.17235/reed.2023.9992/2023

Letter

Duodenal stenosis surgical treatment in Crohn’s disease

DOI: 10.17235/reed.2023.9521/2023

Digestive Diseases Image

Peristomal cutaneous Crohn's disease by contiguity

DOI: 10.17235/reed.2022.8909/2022

Editorial

Chronic intestinal failure: an overview and future perspectives

DOI: 10.17235/reed.2022.8827/2022

Letter

Anal neoplasia and perianal Crohn’s disease: myth or reality?

DOI: 10.17235/reed.2021.8317/2021

Review

Intestinal failure in adults and children

DOI: 10.17235/reed.2020.6981/2020

Letter

Crohn’s disease in patients treated with etanercept

DOI: 10.17235/reed.2019.6554/2019

Original

Mercaptopurine and inflammatory bowel disease: the other thiopurine

DOI: 10.17235/reed.2016.4546/2016

Letter to the Editor

Adnexal localization of Crohn’s disease and recurrent massive ovary cysts

DOI: 10.17235/reed.2016.4301/2016

Case Report

Metastatic Crohn’s disease in pediatrics

DOI: 10.17235/reed.2016.3948/2015

Letter to the Editor

Crohn’s disease and Sweet’s syndrome: A debut together

DOI: 10.17235/reed.2015.3842/2015

Case Report

Ovarian involvement in Crohn´s disease: A rare complication

DOI: 10.17235/reed.2015.3764/2015

Citation tools
Zheng X, Peng X, Xie X, Lian L, Wu X, Hu J, et all. Enteral nutrition is associated with a decreased risk of surgical intervention in Crohn’s disease patients with spontaneous intra-abdominal abscess. 5116/2017


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1242 visits.
This article has been downloaded 328 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 10/06/2017

Accepted: 31/07/2017

Online First: 05/10/2017

Published: 04/12/2017

Article revision time: 45 days

Article Online First time: 117 days

Article editing time: 177 days


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology