ENF References and Abstracts

Selected Abstracts

Home enteral nutrition with formula diets.

Author Russell RI

Source Z Gastroenterol, 23 Suppl:1985 Aug, 94-7
 

Abstract Home enteral nutrition can be successfully used on a long-term basis to maintain nutrition and a reasonably normal lifestyle in patients with chronic intestinal dysfunction. Patients can be easily taught the methods involved, a nocturnal regime allowing a more normal lifestyle. The use of a pump-controlled system is recommended. Side-effects are few, generally transient and not severe. Home enteral nutrition has advantages over home intravenous feeding with respect to ease of administration and organisation, fewer and less severe complications, and cost.

Elemental diets in the prophylaxis and therapy for intestinal lesions: an update.

Author Bounous G

Address Department of Surgery, Montreal General Hospital, Quebec, Canada.

Source Surgery, 105: 5, 1989 May, 571-5
 

 Abstract The recognition of potentially noxious physiologic substances in the intestinal milieu prompted the use of an "elemental" semihydrolyzed formula diet in the prophylaxis of experimental acute ischemic enteropathy. Elemental diets have been used in the management of a variety of digestive diseases. An elemental diet protects the intestinal mucosa of rodents from radiation injury and facilitates mucosal healing. Clinical trials have shown the benefits of this form of treatment in the prevention of acute radiation enteropathy and in the therapy for delayed radiation enteropathy and Crohn's disease.

Elemental diet as primary treatment of acute Crohn's disease: a controlled trial.

Author O'Mor?n C; Segal AW; Levi AJ

Source Br Med J (Clin Res Ed), 288: 6434, 1984 Jun 23, 1859-62
 

Abstract Acute exacerbations of Crohn's disease are usually treated with prednisolone or potentially more toxic immunosuppressive drugs or by surgery. In pilot studies replacing the normal diet by a protein free elemental diet also induced remission. A controlled trial was therefore conducted in which 21 patients acutely ill with exacerbations of Crohn's disease were randomised to receive either prednisolone 0.75 mg/kg/day or an elemental diet (Vivonex) for four weeks. Assessment at four and 12 weeks showed that the patients treated with the elemental diet had improved as much as and by some criteria more than the steroid treated group. Elemental diet is a safe and effective treatment for acute Crohn's disease.

 The effect of an elemental diet with and without gluten on disease activity in dermatitis herpetiformis

Author Kadunce DP; McMurry MP; Avots-Avotins A; Chandler JP; Meyer LJ; Zone JJ

Source J Invest Dermatol, 1991 Aug, 97:2, 175-82
 

Abstract Elemental diets are reported to decrease activity of patients with dermatitis herpetiformis. We tested the hypothesis that gluten, given in addition to an elemental diet, is responsible for the intestinal abnormalities, cutaneous immunoreactant deposition, and skin disease activity in dermatitis herpetiformis. At entry eight patients with dermatitis herpetiformis, who were consuming unrestricted diets, were stabilized on their suppressive medications at dosage levels that allowed individual lesions to erupt. Six patients were then given an elemental diet plus 30 of gluten for 2 weeks, followed by the elemental diet alone for 2 weeks. Conversely, two patients received an elemental diet alone for 2 weeks followed by an elemental diet plus gluten during the final 2 weeks. Small bowel biopsies, skin biopsies, and clinical assessments were done at 0, 2, and 4 weeks. Suppressive medication dose requirement decreased over the 4 weeks by a mean of 66%. Six of eight subjects significantly improved clinically during the gluten-challenge phase of the elemental diet and all were improved at the end of the study. The amount of IgA in perilesional skin did not change significantly, but the amount of C3 increased in five of seven evaluable subjects after gluten challenge. Circulating anti-gluten and anti-endomysial antibodies were not significantly affected by the diets. All subjects completing evaluable small bowel biopsies (seven of seven) demonstrated worsening of their villus architecture (by scanning electron microscopy and intraepithelial lymphocyte counts) during gluten challenge and improvement (six of six subjects) after 2 weeks of elemental dietary intake. We conclude that 1) there is a significant improvement in clinical disease activity on an elemental diet, independent of gluten administration, 2) small bowel morphology improves rapidly on an elemental diet, and 3) complement deposition but neither IgA deposition nor circulating antibody levels correlate with gluten intake. It seems likely that dietary factors other than gluten are important in the pathogenesis of the skin lesions in dermatitis herpetiformis.

Ten years' experience with an elemental diet in the management of Crohn's disease.

Author Teahon K; Bjarnason I; Pearson M; Levi AJ

Address Section of Gastroenterology, MRC Clinical Research Centre, Harrow, Middlesex, UK.

Source Gut, 31: 10, 1990 Oct, 1133-7
 

Abstract The immediate and long-term outcome of treating patients with acute Crohn's disease with an elemental diet was studied retrospectively. Successful diet induced remission was achieved in 96 of 113 patients (85%) regardless of age, sex, site or severity of disease, or associated complications of strictures, fistula, or perianal disease. Treatment was unsuccessful in 17 patients (15%), but there were no features at the outset of treatment that distinguished these patients from those who had successful remission. The longterm outcome of treatment was assessed over a five year period by analysis of life tables and survival curves. Twenty two per cent of the patients relapsed within six months of treatment and thereafter the annual relapse rate was 8-10%. Patients with disease complicated by fistula or perianal involvement had early relapse, approaching 100% for the latter. A further retrospective comparison of longterm outcome of diet vs steroid induced remissions showed no significant difference in the relapse rates between the two groups at one, three, and five years.

Dermatitis herpetiformis: consequences of elemental diet.

Author Zeedijk N; van der Meer JB; Poen H; van der Putte SC Source Acta Derm Venereol, 1986, 66:4, 316-20

Abstract The administration of an Elemental Diet to 5 patients with dermatitis herpetiformis, requiring high doses of Dapsone (diaminodiphenylsulfone, DDS), showed a rapid and beneficial effect on the skin lesions within two weeks. This effect was not influenced by simultaneous gluten challenge in one patient. A possible explanation is a reduction in the amount of harmful immune complexes due to the elimination of proteins from the diet. Subsequent introduction of a more comprehensive diet led to an increase of the minimal effective dose of Dapsone. These results underline the importance of dietary influences on the skin activity in dermatitis herpetiformis, other than gluten alone.

Elemental diet in the management of Crohn's disease during pregnancy.

Author Teahon K; Pearson M; Levi AJ; Bjarnason I

Address Section of Gastroenterology, MRC Clinical Research Centre, Middlesex.

Source Gut, 32: 9, 1991 Sep, 1079-81
 

Abstract Four patients with Crohn's disease were treated with an elemental diet during pregnancy. Two had active disease and two also had symptoms of small intestinal obstruction. All went into a clinical remission within a few days of starting treatment. Treatment periods varied from two to four weeks, and were followed by elemental diet as a supplement to normal food in two patients. At term, all delivered a healthy infant. These patients indicate that elemental diet is a safe form of treatment for Crohn's disease during pregnancy and may be considered as an alternative to conventional drug treatments which carry a theoretical risk of teratogenesis.

Oro-facial granulomatosis. Response to elemental diet and provocation by food additives.

Author Sweatman MC; Tasker R; Warner JO; Ferguson MM; Mitchell DN

Source Clin Allergy, 16: 4, 1986 Jul, 331-8
 

Abstract We report the case of an 8.5-year-old girl with oro-facial granulomatosis associated with clinical atopy, in whom relapse of her granulomatous disorder was shown to be related to exposure to specific food additives, viz. carmoisine, sunset yellow and monosodium glutamate. Treatment with a restricted diet resulted in considerable regression in the facial swelling which has been maintained for 6 months. A brief account of the histological features, both under light and electron microscopy, is given, together with a description of the use of nuclear magnetic resonance scanning in the assessment of this disease. The patient had no evidence to support a diagnosis of sarcoidosis or Crohn's disease.

 

Winitz M., et al Evaluation of chemical diets as nutrition for man-in-space. Nature 1965, 4973; 741-743

Young DS, Epley JA, Goldman P. Influence of a chemically defined diet on the composition of serum and urine. Clin Chem 1971;17-8:765-773

Perrault J . et al Effects of an elemental diet in healthy volunteers. Gastroenterology 64:569-576 1973

Winitz W. At al Studies in metabolic nutrition employing chemically defined diets Am Jour Clin Nutr 23;5, 1970 525-545 and Effects on Gut Microflora ibid 546-559

Voigt AJ, Echave V, Feller JH, et al. Experience with elemental diet in the treatment of inflammatory bowel disease. Is this primary therapy? Arch Surg 1973;107:329-33

Russell R.I Progress Report Elemental Diets. Gut 1975,16; 68-79

Morin Cl et al Continuous elemental enteral alimentation in the treatment of children and adolescents with Chron's disease. J Parent Nutr 1982;6:194-199

Russell Robin I Elemental Diets. CRC Press Inc. Boca Raton Florida 1981

Rocchio M.A., Cha C.M., Haas K.F., Randall H.T. Use of chemically defined diets in the management of patients with acute inflammatory bowel disease. Am. Jour. Surgery 1974,127:471-475.

O'Morain C, Segal AW, Levi AJ et al Elemental diet as a primary treatment of acute Crohn's Disease; a controlled trial. Br. Med J 1984:288:1859-62

Frieri et al. Preliminary investigation on humoral and cellular immune responses to selected food proteins in patients with Crohn's disease. Ann Allergy 1990;64:345-351

Jones VA, Workman E, Freeman AH et al. Chron's Disease: Maintainence of Remission by Diet

Villaveces J.W., Heiner D.C. Experience with an Elemental Diet. Annals of Allergy Dec. 1985, 55: 783-787.

Hill D.J., Lynch B. Elemental diet in the management of severe eczema in childhood. Clin. Allergy 1982;12: 312-315.

Lucio A. et al Food hypersensitivity and Atopic dermatitis. Allergy 1989; 44 (suppl.9) 140-146.

Osterballe H.O, Bundgaard B., Weeke B., Weiss, M. Double-blind controlled trial of Elemental Diet in severe, perennial asthma. Allergy 1981,36:257-262

Hughes E.C., Gott P.S., Weinstein R.C. Binggeli R. Migraine: a diagnostic test for etiology of food sensitivity Annals of Allergy, 1985, 55; 28-32.

Saverymuttu S., Hodgson H.J. F., Chadwick V.S. Controlled Trial comparing prednisolone with an elemental diet plus non-absorbable antibiotics in active Crohn's disease. Gut,1985, 26; 994-998

Belli DC, Seidman A, Bouthillier L, et al. Chronic intermittent elemental diet improves growth failure in children with Crohn's disease. Gastroenterology 1988; 94:A37

O'Morain C, Segal AW, Levi AJ et al Elemental diet as a primary treatment of acute Chron's Disease; a controlled trial. Br. Med J 1984:288:1859-62

Workman EM, Jones AJ, Hunter JG. Diet in the Managment of Crohn's Disease. Human Nutr.1984:38A:469-473

Teahon K., Bjarnason I., Pearson A.J., Levi A.J. Ten years experience with an elemental diet in the management of Crohn's diease. Gut,1990,31;1133-1137

Knicker W. Non-IgE Mediated and Delayed Adverse reactions to Food or Additives. Handbook on Food Allergies, Ed Breneman J.C.; Marcel Dekker Inc. N.Y. 1985.

Brostoff J. Mechanisms: Food Allergy and Intolerance; Balliere Tinbdal; 1987

Gardner MLG. Evidence for, and Implications of, Passage of Intact Peptides Across the Intestinal Mucosa. 1983 Biochem. Soc Trans 11; 813

Reinhardt M.C. Macromolecular Absorption of Food Antigens in Health and Disease. 1984 Ann Allergy.53.597-601

McNeish, A.S.Enzymatic Maturation of the Gastrointestinal Tract and its Relevance to Food Allergy and Intolerance in Infancy. 1984 Ann Allergy 53: 643

Lucio A. et al Food hypersensitivity and Atopic dermatitis. Allergy 1989; 44 (suppl.9) 140-146.

Nsouli TM et al Role Of Food Allergy In Serous Otits Media. Ann Allergy 1994;73:215-219

Wraith D.G. Asthma in Food Allergy and Intolerance. Brostoff and Challicombe ed. 486-497; 1987.

Osterballe H.O, Bundgaard B., Weeke B., Weiss, M. Double-blind controlled trial of Elemental Diet in severe, perennial asthma. Allergy 1981,36:257-262

Vincent J. Avoidance therapy: time-tested methods to treat asthma. Fam. Prac. Recert. 1990; 12(11): 71-87.

Hughes E.C., Gott P.S., Weinstein R.C. Binggeli R. Migraine: a diagnostic test for etiology of food sensitivity Annals of Allergy, 1985, 55; 28-32.