malnutrition in patients with crohn's disease in remission. effect of an elemental diet
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F37 IS TUBE FEEDING AN ALTERNATIVE TO PARENTERAL NUTRITION IN THE TREATMENT OF CROHN'S DISEASE? H.Lochs, M.Egger-Schodl, R.Potzi, Ch.Kappel, R.Schuh. I. Univ.Klinik of Gastroenterolov and Hepatoloov, Vienna, Austria.
Parenteral nutrition (PN)-;s well establrshed as therapy of the acute phase of Crohn's disease (CD). However there are some disadvantages with regard to immobility of the patients and risk of infection. We therefore tried to answer the question if tube feeding could be an alternative the- rapy in acute phase of CD. 20 patients with CD were randomized into two groups. Group I was treated with parenteral nutrition, group II with tube feeding. Indication for therapy was a Crohn's disease activity index(CDA1) above 150 and/or body weight less than 80% of ideal body weight (IBW). For PN a complete nutrition solution containing 1509 glucose, 509 sorbitol, 509 amino acids, 509 fat, electrolytes, trace elements and vitamines per 1 was infused via a central venous catheter in a dosage of approximately 3000 kcalldav. For tube feedinq an elemental diet was infused via a Dob- hoff type.tube into the duodenum in a dosage of approximately 2400 kcal/ day. As parameters body weight expressed as % IBW, albumin, hemoglobin and the CDAI were used. The results are given in the table:
% IBW Alb.g/l HB g/d1 CDAI duration before after before after before after before after of therapy d
PN 73 84 34 37 11 11 209 115 29 Tube feeding 83 88 36 36 12 10 223 131 32 In both groups the nutritional status was improved and CDAI was reduced by therapy. Group I did gain more body weight than group II according to the higher caloric content of PN. No difference existed between the 2 groups according to CDAI at the beginning and at the end of the study. Albumin and hemoglobin was within normal range in most patients before the study and did not change significantly. We concluded, that the effect of tube feeding with elemental diets for the acute phase of CD is comparable to the effect of PN. Therefore tube feeding is a real alternative to PN in the treatment of such patients.
F38MALNUTRITION IN PATIENTS WITH CROHN'S DISEASE IN REMISSION. EFFECT OF AN ELEMENTAL DIET: G.A. Lanfranchi, C.Brignola, M.Campieri, G.Bazzocchi, R.Pasquali, G.Baraldi. Istituto di Clinica Medica e Gastroenteroloqia - Universitd die Bologna, Italy.
Malnutrition is frequently recorded in chronic deseases with involvement of gastrointestinal tract such as Crohn's Disease fCD1. The aim of this study was to investigate nutritional sta- &s'in outpatients with CD-in remission or-in a stage of low activity (CDAI < 250). Nutritional status was evaluated in 44 consecutive outpatients. 18 of these patients were below 90% of ideal weight and of these 5 were below 80%. The analysis of the body composition showed a mean decrease of the triceps skin- fold (84+35% of ideal value) or of the arm muscle circumference (AMC) (81+8% of ideal value). The alteration of weight and AMC was great& in patients with mildly active disease (pCO.005) and in those with ileal and ileocolic involvement. Caloric in- take. assessed bv seven day questionnaire, was generally good: 35,9+11 KCal/Kg ideal weightjday. Creatinine-Height Index was elevated in 55% of the whole group. Seven underweight patients accepted to assume an alimentary in- tegration with elemental diet: the basal mean caloric intake of these subjects was 37.9+5 KCal/Kg Ideal weight/day. After 1 month weight-maintenance diet period of the diet above, 10 KCal/ Kg Ideal weight/day of elemental diet (Precision brR, Wander) were administered as suoolementum (carbohydrates 81.9X, protein 10%) for two months. After this period, we observed a signifi- cant increase (~(0.01) of body weight (mean 1.3% of basal weight after 1 month,‘mean 3%.after Z-months) and of sum of skinfolds (mean 6.4% of basal value after 1 month, mean 9.4% after 2 months). No significant change was observed for AMC.