Meta-analysis of enteral nutrition as a primarytreatment of active Crohnʹs disease

The efficacy of enteral nutrition as primary therapy of activeCrohnʹs disease is controversial. The aim of the study was to compare by meta-analysis the likelihood of clinical response to liquid diet therapy vs. corticosteroids and to assess the importance of formula composition to efficacy. Methods: Randomised controlled trials comparing exclusive enteral nutrition with corticosteroids and elemental with non-elemental formulas were identified through a combination of computerised and hand-searching techniques. Rates of clinical remission of active Crohnʹs disease, based on the intention to treat principle, were extracted from the studies by two independent reviewers. Odds ratios for the likelihood of clinical response were calculated. Results: In eight trials comprising 413patients, enteral nutrition was inferior to corticosteroids (pooled odds ratio 0.35; 95% confidence interval 0.23–0.53). In five trials comprising 134 patients, there was no difference in the efficacy of elemental versus nonelemental formulas (pooled odds ratio 0.87; 95% confidence interval 0.41–1.83). Conclusions: Corticosteroids are more effective than enteral nutrition in the treatment of active Crohnʹs disease. Limited sample size precludes definite conclusions about the importance of formula composition in the efficacy of enteral nutrition; however, data analysed in this study do not support an advantage to elemental feedings compared with a polymeric formulation.