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Query: UMLS:C0010346 (Crohn's disease)
 21,615 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In seven patients, six with Crohn's disease and one with pancreatitis, two methods of parenteral nutrition were compared: the partial consecutive administration of the components of a parenteral nutrition regimen versus the administration of all nutrients simultaneously. With respect to the consecutive regimen, the simultaneous infusion regimen gave an improvement in the nitrogen balance of 13% and a decrease in urinary lactic acid of about 50%. Urinary excretion of alpha-amino nitrogen, glucose, and fructose was very small in both cases but was slightly lower during the simultaneous infusion regimen. The improvement in the nitrogen balance attained with the simultaneous infusion regimen can be explained by the fact that infused nutrients, especially carbohydrates, cause fewer metabolic disturbances. The simultaneous infusion regimen has three other advantages. The patients rarely complain of headache and nausea, the infusion regimen is markedly simplified and the risk of contamination when nutrients are added to the infusion bottles in the ward is considerably diminished.
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PMID:Simultaneous and consecutive administration of nutrients in parenteral nutrition. 11 Jan 30

21 patients with gastroenterological disease and indication for the use of intravenous nutrition received an elemental diet (ED) for 5-44 days. In 6 out of 8 patients with exacerbation of Crohn's disease remissions were achieved, apart from 3 persistent fistulas. In 5 out of 9 cases with various primary diseases and postoperative intestinal fistulas, spontaneous healing was observed. Furthermore, 2 patients with ulcerative colitis, 1 with radiation enteritis and 1 with pancreatitis were treated with ED. On ED, hemoglobin increased from 11.3 +/- 0.4 (m +/- SEM) to 12.0 +/- 0.5 g% (p less than 0.01) and serum albumin from 2.7 +/- 0.1 to 3.4 +/- 0.1 g% (p less than 0.001). Nitrogen requirements were studied in 11 patients receiving various quantities of ED. Nitrogen balance was found to be in equilibrium or positive in 7 patients, and negative in 4. In one patient with severe ulcerative colitis, fecal nitrogen losses were higher than urinary nitrogen losses. The unpleasant taste of ED resulting from free amino acids limited the ED supply in 3 patients and led to premature ending of ED administration in 3 other patients. In such cases ED may be given by nasogastric tube feeding. From the results presented it appears that ED is indicated in Crohn's disease and intestinal fistulas. However, the results obtained require confirmation by further observations and comparison with an intravenously fed control group.
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PMID:[Elementary diet as an alternative to parenteral feeding in severe gastrointestinal diseases]. 40 20

The acute phase of Crohn's disease in a 14 year old female was effectively treated with total parenteral nutrition (TPN) and an elemental diet (ED). Acute abdominal symptoms subsided at once. With TPN there was a daily nitrogen retention of 3,2-5.6 grams. With ED nitrogen retention decreased presumably because of the reduced nitrogen content of the oral diet. During the 7 weeks of treatment body weight increased 7 kgrams. Observed skin lesions were caused by zinc deficiency.
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PMID:[Clinical and metabolic studies in the acute stage of Crohn's disease with total parenteral feeding and elementary diet]. 41 Jul 33

Growth arrest and delayed onset of puberty often complicate childhood onset Crohn's disease of the small bowel (granulomatous enteritis). Nutritional deficits arising from inadequate dietary intake, malabsorption, and increased caloric needs may contribute to growth retardation. To assess whether a sustained high caloric and nitrogen intake could reestablish growth, 4 children with extensive Crohn's disease of the small bowel were studied before and after parenteral alimentation which was instituted for symtomatic disease control. Weight gain, positive nitrogen balance, and improved nutritional status were achieved during parenteral alimentation in each patient. In 2 patients weight gain was sustained using oral nutritional supplements, and a substantial increase in linear skeletal growth continued in the ensuing months. One patient entered puberty within 4 months of parenteral alimentation and another had the onset of menarche and the development of secondary sex characteristics 4 months after parenteral alimentation and resection of diseased bowel. Growth may be reestablished in some growth-arrested children if intake is sufficient to establish a sustained positive caloric and nitrogen balance. Nutritional requirements imposed by the demands of growth and active disease and often compounded by the catabolic effects of corticosteroids may be excessive; growth may occur only if these needs are met orally and/or parenterally.
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PMID:Reversal of growth arrest in adolescents with Crohn's disease after parenteral alimentation. 81 57

In a patient with total colectomy and only 120 cm of the proximal small bowel remaining after resection for Crohn's disease, comparative studies were performed on the absorption of isocaloric amounts of Vivonex HN, Flexical, Codelid, Jejunal, and Precision LR. These elemental and/or complete diets were fed by a nasogastric tube at a constant rate of 260 ml/hr, 1 cal/ml, 2185-2660 ml per feeding period of 8.4-10.2 hr daily. Discharge of intestinal fluids from the jejunal stoma ranged between 2940 ml (Vivonex HN) to 4760 ml (Jejunal) per daily feeding period, resulting in a net intestinal loss of fluids and dehydration with the exception of Flexical. Jejunostomy discharge on Flexical was only 1325 ml per comparable period. The patient tolerated dietary fat relatively well absorbing 61% of 87 g of fat from Flexical and 60% of 108 g from a natural blenderized diet. The other diets used were either fat-free or with a minimum amount of fat. The second best tolerated diet was Vivonex HN, the feeding of which resulted in the highest intestinal retention of nitrogen (84% of the 16.3 g fed as opposed to 78% of 9.1 g fed in Flexical). Vivonex HN also had the highest intestinal retention of phosphorus. Intestinal fluid absorption was not related to the intestinal transit time measured by a nonabsorbable marker or to the osmolality of diets. Diets containing fat may inhibit secretion by the "enterogastrone-like" effect induced by dietary fat in the remaining bowel. High amino acid content of some of the low-fat diets may release gastrointestinal hormones which stimulate secretion, and the simple carbohydrates prevent fluid absorption. In the short-bowel syndrome with normal functions of the pancreaticobiliary system, diets based on fat and protein hydrolysate should be the nutritional therapy of choice.
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PMID:Absorption of different elemental diets in a short-bowel syndrome lasting 15 years. 82 Jan 89

Crohn's disease and ulcerative colitis may cause excessive nutritional deficits as a consequence of inadequate intake, excessive losses, impaired absorption and increased metabolic requirements. This fact also influences the prognosis of medical and surgical treatment. Parenteral hyperalimentation or the combination of parenteral nutrition with a synthetic "space diet" lowers the risks of surgical treatment; other purposes are promoting positive nitrogen balances and weight gain as well as closure of enterocutaneous fistulas.
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PMID:[Parenteral-peroral combined treatement of Crohn's disease and ulcerative colitis]. 82 60

To identify potentially remediable abnormalities in Crohn disease, 63 patients had evaluations performed for anemia, electrolyte deficiencies, defects of carbohydrate, fat, nitrogen, and vitamin B12 absorption, and jejunal bacterial overgrowth. Ninety percent of the group had two or more potentially correctable defects. More than 50% had anemia associated with iron or folate deficiency of vitamin B12 malabsorption; 33% had low levels of serum sodium, potassium, calcium, or magnesium either singly or in combination; 22% had lactose intolerance, fat malabsorption was persent in 31%; 75% had evidence of disturbed protein metabolism; and bacterial overgrowth of the upper part of the small bowel was identified in 30% of 47 patients.
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PMID:Remediable defects in Crohn disease: a prospective study of 63 patients. 105 64

In haematological diseases, insufficient data has been accumulated to evaluate the efficacy of immunosuppressive drug treatment in patients with erythroid aplasia or sideroblastic anaemia. Cyclophosphamide may be efficacious in inhibiting circulating anticoagulants in patients who need continued replacement of clotting factors. Azathioprine, 6-mercaptopurine, cyclophosphamide and vincristine have been used successfully in treating patients with idiopathic thrombocytopenic purpura, and some patients with auto-immune haemolytic anaemia may benefit from the addition of purine analogues. However, the use of immunosuppressive therapy seems to accelerate the presence of haematological malignancies in patients with macroglobulinaemia. In gastro-intestinal diseases, uncontrolled studies have shown nitrogen mustard, 6-mercaptopurine and azathioprine to be of modest benefit to patients with ulcerative colitis and Crohn's disease. In a controlled trial azathioprine plus prednisone proved more effective than prednisone alone in sustaining remission in patients with Crohn's disease. In patients with either chronic active hepatitis or primary biliary cirrhosis, however, there seems to be no benefit from immunosuppressive therapy for primary treatment of these diseases. Cyclophosphamide, azathioprine and methotrexate have all been used with some success in treating patient with uveitis, and in a controlled trial cytarabine has been shown to be beneficial to patients with herpes ophthalmicus. However, no benefit has been shown to patients with the eye changes of Graves' disease with either azathioprine or methotrexate. Patients with Paget's disease appear to be helped by mithramycin. Cyclophosphamide, chlorambucil and azathioprine are ineffective in treating patients with multiple sclerosis. 6-Mercaptopurine, azathioprine, methotrexate and cyclophosphamide have all produced some benefit in patients with myasthenia gravis, and some patients with idiopathic pulmonary haemosiderosis have responded to azathioprine, 6-mercaptopurine and cyclophosphamide. Alkylating agents have proved useful in treating some patients with asthma and in treating frequent relapsers among children with the nephrotic syndrome. In adults with membrano-proliferative glomerulonephritis some patients have responded to combination therapy with cyclophosphamide, azathioprine and corticosteroids. Immunosuppressive therapy is also indicated in prolonging graft survivals in patients receiving organ transplants. Drug toxicities of immunosuppressive agents are discussed. Their long-term effects, including mutagenic potential, have as yet not been fully elucidated.
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PMID:Clinical use of immunosuppressive drugs: part II. 127 59

Crohn's disease involves a great risk of malnutrition. Malabsorption, bacterial contamination, frequent abdominal surgery, meal-related pain, protein loss through the damaged mucosa contribute to creating nutritional problems. Malnutrition can worsen the outcome, both in medical and surgical patients, and deteriorate an often already altered immune response. Weight loss, low levels of blood protein, electrolytes, micronutrients and vitamins are usually related to the extension of the mucosal damage. Nutritional assessment can be difficult due to oedema and bleeding, who interfere with both clinical and laboratory evaluation. The exact amount of nitrogen, lipids, minerals stool loss can be useful. It is widely accepted the use of nutritional support in Crohn's disease, but many Authors do not agree concerning the route (enteral or parenteral) and the kind of nutrient to be used. Still controversial is the role of nutrition: just support or real therapy? Most recent hypothesis concerning the pathogenesis of Crohn's disease indicate food and/or bacterial antigens as involved in determining the pathology. The "bowel rest", considered for many years as a fasting period necessarily supported by parenteral nutrition, can also be obtained by the temporarily reduction or stop in presenting those antigens to the bowel mucosa. This new concept can be achieved not only by parenteral nutrition, but with an enteral elemental diet as well. The elemental diet contains all nutrients in the simplest way and thus succeeds in lowering or eliminating the antigenic power. The reported results seem to indicate an equivalence of enteral and parenteral nutrition; anyway enteral is advisable when feasible, being more physiological and less expensive and involving a lower risk of serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Possibilities and limitations of nutritional support in Crohn disease]. 129 38

It is clear that the nutritional state of patients with inflammatory bowel disease is often impaired and can be improved by the provision of nutritional support. Improvement in nutritional status can be achieved as effectively with enteral as with parenteral nutrition. Nutritional support appears to have no primary therapeutic effect in patients with ulcerative colitis. With regard to nutritional support in Crohn's disease, parenteral nutrition should be restricted to use as supportive rather than primary therapy. Available information now seems to suggest that most of the benefits of parenteral nutrition in Crohn's disease are related to an improvement in nutritional state rather than as primary therapy, and its use should be restricted to the treatment of specific complications of Crohn's disease, such as intestinal obstruction related to stricture formation or short bowel syndrome following repeated resection. Although some doubt exists over the efficacy of oligopeptide-containing elemental and polymeric enteral diets, the present evidence indicates that chemically defined free amino acid-containing elemental diets have primary therapeutic efficacy in the management of acute exacerbations of Crohn's disease. As such, these diets are worthy of therapeutic trial in patients with severe Crohn's disease involving the distal colon and rectum, particularly in those patients who are malnourished and who prove to be resistant to treatment with a combination of topical corticosteroids and 5-aminosalicylic acid-containing compounds. Clinicians should be aware, though, that the beneficial effects are likely to be restricted to the short term, with high relapse rates by 1 year, this being particularly so in patients with distal Crohn's proctocolitis (Teahon et al, 1988). Volatile fatty acid enemas clearly have potential in the management of patients with severe steroid-resistant proctitis. Finally, one of the most important observations made in recent years is the one concerning the large losses of nitrogen that will occur in patients with inflammatory bowel disease treated with corticosteroids in the absence of adequate protein intake (O'Keefe et al, 1989). Hopefully the days of treating patients with severe inflammatory bowel disease with high dose corticosteroids and a peripheral dextrose or dextrose-saline drip have passed into history.
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PMID:Medical management of severe inflammatory disease of the rectum: nutritional aspects. 131 93


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