Nutritional support for Crohn's disease

Nutritional considerations are intimately associated with Crohn's disease. Food antigens and dietary factors have been postulated to have a role in its pathogenesis, and the disease leads to decreased absorptive capacity of the gut. Malnutrition is a common manifestation of Crohn's disease, necessitating close monitoring of patients and rapid nutritional intervention to correct deficiencies. The indications for supportive nutritional therapy are well defined and include measures to improve patients' nutritional status and growth and development; decrease perioperative complications; and manage complications of Crohn's disease, including enterocutaneous fistulas and short-bowel syndrome. Nutritional therapy as a first-line treatment of Crohn's disease is controversial. Although enteral nutrition has been found to have efficacy in this setting, steroid therapy is the gold standard treatment of acute Crohn's disease, with enteral nutrition reserved for steroid-resistant or steroid-intolerant patients. An emerging use of supplementary enteral nutrition is in the maintenance of Crohn's disease remission. Interestingly, this benefit seems to be associated with improvement in patients' nutrition, suggesting a relationship between nutritional status and disease activity. Further insight into this field, including the potential of micronutrients to promote trophic, healing, and immunomodulatory effects on the gut, may lead to novel and efficacious treatments of this disease.