Enteral feeding as sole treatment for Crohn's disease: controlled trial of whole protein v amino acid based feed and a case study of dietary challenge
Article Abstract:
Crohn's disease is an inflammatory condition of unknown origin that affects the digestive tract; most often, the small intestine and colon are involved. Although treatment has traditionally emphasized the need for 'bowel rest', including intravenous feedings and avoiding eating, there is increasing evidence that significant improvement in cases of Crohn's disease can be induced by dietary treatment alone. To evaluate the effects on patients of an elemental diet (composed mainly of amino acids and carbohydrates), a study was carried out of 24 patients with active Crohn's disease. The patients were randomly assigned to receive either an amino acid-based liquid diet or a liquid diet based on whole milk protein. Those who responded favorably within three weeks to whichever diet they were originally assigned were switched to the alternate diet. Improvement, determined by standard measures of disease activity, was seen in similar proportions of patients given the amino acid diet (9 of 13) and whole protein diet (8 of 11). None of the six patients originally assigned to the amino acid diet relapsed (suffered a return of symptoms) when switched to the protein diet, but three of seven protein diet patients relapsed when they were switched to the amino acid diet. A detailed report is presented of one patient who began a carefully planned reintroduction of selected food components over a four-year period. The patient did well with many foods (bread, meat, dairy products) but relapsed when he ate others (green vegetables). In cases of relapse, a return to the liquid diet brought remission. These results indicate that administering food into the intestine (enteral feeding), rather than intravenously, can be effective in treating Crohn's disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Gut
Subject: Health
ISSN: 0017-5749
Year: 1991
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Referral of patients with primary biliary cirrhosis for liver transplantation
Article Abstract:
Biliary cirrhosis, an ultimately fatal liver disorder, is the most common cause of referral for liver transplantation in the UK. A far smaller number of suitable donors than needy recipients makes careful selection of recipients necessary. Recipients should include those who have little chance of survival without the transplant, but are not so ill that the transplant will do them no good. To investigate how successful this selection process has been in the UK, the records of all 107 patients referred to Queen Elizabeth Hospital in Birmingham, UK between 1981 and 1989 for liver replacement as a result of primary biliary cirrhosis were analyzed. Prognosis for survival was estimated by applying a statistical model and measuring serum bilirubin (a bile pigment). Seventy of the 107 patients received transplants, with an overall one-year survival rate of 62 percent. Both the statistical model and serum bilirubin levels were good predictors of survival, with the upper one-third of the predicted survivors showing a 78 percent survival rate, and the lower one-third having only a 50 percent survival rate. No trend toward earlier referral was seen in the later years of the study as compared with earlier years. A better outcome may be provided for liver transplant recipients if referrals are made early in the course of the disease. It is recommended that patients with primary biliary cirrhosis be referred for liver transplant before serum bilirubin levels exceed 150 micromoles per liter to maximize chances for postoperative survival. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Gut
Subject: Health
ISSN: 0017-5749
Year: 1990
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- Abstracts: Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent diabetes mellitus
- Abstracts: Superoxide production by Crohn's disease neutrophils. Candidacidal activity of Crohn's disease neutrophils. Antibody to selected strains of Saccharomyces cerevisiae (baker's and brewer's yeast) and Candida albicans in Crohn's disease