Adherence to an elemental diet for preventing postoperative recurrence of Crohn's disease

作者：Ohara Nobuyoshi; Mizushima Tsunekazu^*; Iijima Hideki; Takahashi Hidekazu; Hiyama Satoshi; Haraguchi Naotsugu; Inoue Takahiro; Nishimura Junichi; Shinzaki Shinichiro; Hata Taishi; Matsuda Chu; Yamamoto Hirofumi; Doki Yuichiro; Mori Masaki

来源：Surgery Today, 2017, 47(12): 1519-1525.

DOI：10.1007/s00595-017-1543-5

• Crohn's disease
• Postoperative recurrence
• Elemental diet
• Adherence

Purpose An elemental diet (ED) can suppress inflammation in patients with Crohn's disease (CD); however, adherence to this diet is difficult. We examined the correlation between ED adherence and the postoperative recurrence of CD.
Methods The subjects of this study were 38 patients who underwent intestinal resection with anastomosis. We defined ED adherence as consuming the average daily ED dose (>= 900 kcal/day) for 2 years after surgery. Patients who did not adhere to the ED were allocated to the non-ED group. We diagnosed symptomatic recurrence using the CD activity index and endoscopic recurrence using the Rutgeerts' score.
Results The ED and non-ED groups comprised 21 and 17 patients, respectively, with ED adherence of 55.3% (21/38). At the initial endoscopy, symptomatic and endoscopic recurrence rates were 4.8 and 14.3%, respectively, in the ED group, and 23.5 and 41.2%, respectively, in the non-ED group (P = 0.152 and P = 0.078, respectively). The overall symptomatic recurrence-free duration was significantly longer than the endoscopic recurrence-free duration (P = 0.022). Symptomatic and endoscopic recurrence-free durations were longer in the ED group than in the non-ED group (P = 0.003 and P = 0.021, respectively), and ED adherence was a prognostic factor for endoscopic recurrence (HR = 2.777, 95% CI = 1.036-8.767, P = 0.042).
Conclusion Maintaining ED adherence for 2 years after surgery improved the symptomatic and endoscopic recurrence-free durations.

• 出版日期2017-12