How Effective Is Enteral Nutrition in Inducing Clinical Remission in Active Crohn's Disease? A Meta-Analysis of the Randomized Clinical Trials
| Autor: | Esteve-Comas M, Fernando Fernández-Bañares, Eduard Cabré, Miquel A. Gassull |
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| Rok vydání: | 1995 |
| Předmět: |
medicine.medical_specialty
030309 nutrition & dietetics MEDLINE Medicine (miscellaneous) Disease Enteral administration law.invention 03 medical and health sciences Enteral Nutrition 0302 clinical medicine Crohn Disease Randomized controlled trial law Internal medicine medicine Humans Randomized Controlled Trials as Topic Food Formulated Clinical Trials as Topic 0303 health sciences Crohn's disease Nutrition and Dietetics business.industry Remission Induction Odds ratio medicine.disease Surgery Parenteral nutrition Meta-analysis Steroids 030211 gastroenterology & hepatology business |
| Zdroj: | Journal of Parenteral and Enteral Nutrition. 19:356-364 |
| ISSN: | 1941-2444 0148-6071 |
| DOI: | 10.1177/0148607195019005356 |
| Popis: | The purpose of the study was to evaluate, using meta-analysis techniques, whether enteral nutrition is effective in inducing clinical remission in active Crohn's disease.Randomized trials either comparing enteral nutrition with steroids or comparing elemental (amino acid-based) with nonelemental diets were selected using MEDLINE (1984 to 1994), reference lists from published articles, reviews, and abstracts from major gastrointestinal meetings. Sixteen studies fulfilled the inclusion criteria (four published as abstracts). Crude rates for induction of remission were collected on an intention-to-treat basis by three independent observers. Each study was given a quality score, based on predetermined criteria.The pooled odds ratio (OR) for all type of enteral diets compared with steroid therapy was 0.35 (95% CI, 0.23 to 0.53). This result was similar for the best studies (by quality score) combined, for trials using tube feeding combined, and when noncompliant patients were withdrawn. Further subgroup analyses were conducted on the basis of the type of diet administered. Peptide-based diets were significantly inferior to steroids (pooled OR, 0.32; CI, 0.20 to 0.52). There was a trend to lower remission rate after elemental diets than after steroids (pooled OR, 0.44; CI 0.17 to 1.12). On the other hand, pooled OR for whole protein-based diets compared with elemental diets was 1.28 (CI, 0.40 to 4.02).Data available to date show that steroids are better than enteral nutrition to induce remission in active Crohn's disease. These results are more evident when peptide-based diets are administered, but they are not conclusive when either elemental or whole protein-based diets are used. |
| Databáze: | OpenAIRE |
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