Crohn’s Disease - NUTRITIONAL SUPPORT

Posted by Alex

General Dietary Instructions and Nutritional Supplements

Food is the best source of nutrition, and the emphasis for most patients should be on normalization of the diet and adequate caloric intake. Patients with intestinal strictures and partial obstruction may benefit from a low-residue diet. Those patients with calcium oxalate stones associated with steatorrhea and hyperoxaluria should be instructed in a low-oxalate diet. In patients with extensive ileal resection and steatorrhea, a low-fat diet with medium chain triglyceride supplementation should be considered. These patients need replacement of calcium, vitamin D, and vitamin K as well. Lactose intolerance can mimic the symptoms of Crohn’s disease and should be documented or excluded if there is any question of its existence. A lactose-free diet with calcium supplementation can be offered if appropriate. In addition, patients with evidence of malabsorption, those with a low-calcium intake, and those receiving long-term steroid therapy are at risk for osteoporosis and osteomalacia. Bone density studies and referral for possible therapy with agents to prevent bone disease should be considered. Finally, vitamin B12 replacement may be necessary for patients with moderate or extensive ileal resections or those with chronic extensive ileal disease. A Schilling test should be performed several months postoperatively to document the need in those patients undergoing resection, and routine vitamin B12 levels should be obtained in those with long-standing active ileal disease.

Enteral and Parenteral Diets

Although there is some debate about their actual utility, both enteral diets and total parenteral nutrition have been shown to be useful as primary therapy in inducing remissions in certain patients with Crohn’s disease. This should be considered in particular in patients refractory to pharmacologic therapy, especially in poor operative risk candidates. Such diets can also be used in an attempt to heal fistulas as adjuncts to drug therapy and in helping to prepare patients for surgery. Growth failure in children with Crohn’s disease can often be overcome by increasing caloric intake with elemental diets. Finally, total parenteral nutrition given at home is often a necessity for patients with severe short-bowel syndrome, usually resulting from multiple resections.