Is the frequency of dietitian support associated with greater clinical improvements in adults with Crohn's disease undertaking exclusive enteral nutrition?

BACKGROUND: Exclusive enteral nutrition (EEN) is considered to be an effective, low-risk therapy in the treatment of Crohn's disease (CD). Frequent dietetic support may assist adults to succeed. The present observational study aimed to compare whether the frequency of dietetic support during EEN therapy was associated with differences in clinical and nutritional outcomes across two gastroenterology inflammatory bowel disease services. Site A provided ≥3 visits plus more if clinically indicated and Site B provided weekly support. METHODS: Eligible patients were adults with active CD recommended to be treated with oral EEN for ≥6 weeks between February 2018 and December 2019. Demographic, anthropometric, clinical, medications, pathology and EEN treatment descriptors were sourced from the medical chart. Descriptive statistics, as well as chi-squared and t tests, were used to compare data between sites. RESULTS: Eighty-four CD patients were eligible (44 ± 14 years, 54% female, baseline Crohn's disease activity index [CDAI] 259.5 ± 113.1, n = 51 Site A) and completed EEN for median (range) 6.1 (1-12) weeks. Most patients (82%, n = 69/84) completed ≥6 weeks of EEN treatment. CDAI score and calprotectin improved across the total sample from pre- to post-EEN by -109.8 ± 92.1 (p < 0.001) and -65 µg g-1 (-65,230 to 4370) (p = 0.002), respectively. Dietitian occasions of service were more frequent at Site B (7 [4-12] occasions vs. 3 [1-8], p < 0.001). However, changes in clinical and biomarker data were similar between sites (p < 0.05). CONCLUSIONS: EEN with regular dietetic input resulted in clinical and biochemical improvements for patients with active CD. Tailoring dietetic support based on the client's needs and preference may achieve clinical improvements similar to providing weekly dietetic support to adults on EEN.

Older adults with acute severe ulcerative colitis have similar steroid non-response and colectomy rates as younger adults.

BACKGROUND: There is paucity of data on outcomes of acute severe ulcerative colitis (ASUC) in older adults (≥ 60 years of age). AIM: To assess steroid non-response rates during the index admission for ASUC in older adults. Secondary outcomes were response to medical rescue therapy and colectomy rates; at index admission, 3 and 12 mo. METHODS: This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals. Electronic medical records were reviewed to collect clinical, biochemical, and endoscopic data. A modified Poisson regression model was used for analysis. RESULTS: Of 226 ASUC episodes, 45 (19.9%) occurred in patients ≥ 60 years of age. Steroid non-response rates were comparable in older adults and patients < 60 years of age [19 (42.2%) vs 85 (47%), P = 0.618, crude risk ratio (RR) = 0.89 [95% confidence interval (CI): 0.61-1.30], adjusted RR = 0.99 (0.44-2.21). Rates of response to medical rescue therapy in older adults was comparable to the younger cohort [76.5% vs 85.7%, P = 0.46, crude RR = 0.89 (0.67-1.17)]. Index admission colectomy [13.3% vs 10.5%, P = 0.598, crude RR = 1.27 (0.53-2.99), adjusted RR = 1.43 (0.34-6.06)], colectomy at 3 mo [20% vs 16.6%, P = 0.66, crude RR = 1.18 (0.61-2.3), adjusted RR = 1.31 (0.32-0.53)] and colectomy at 12 mo [20% vs 23.2%, P = 0.682, crude RR = 0.85 (0.45-1.57), adjusted RR = 1.21 (0.29-4.97)], were similar between the two groups. CONCLUSION: In older adults with ASUC, the steroid non-response rate, response to medical rescue therapy, and colectomy rate at index admission, 3 and 12 mo is similar to patients less than 60 years of age.