Artificial nutrition (enteral and parenteral) represents a widespread approach to many gastrointestinal disorders such as intestinal failure and chronic intestinal pseudo-obstruction, inflammatory bowel disease (IBD), severe exocrine pancreatic insufficiency due to cystic fibrosis, enteric and pancreatic fistulas, swallowing disorders, and other conditions secondary to other severe gastrointestinal disease or major digestive surgery leading to malnutrition. The availability of different enteral nutritional formulas, improvements in assessing nutritional status and its relationships with the digestive tract, as well as the progress in the management of artificial nutrition procedures have enhanced its safety, efficacy and scale of use.
Crohn's disease can be an indication for artificial nutrition, improving patient management and also providing some insights into the nature of the disease, for example with regard to the role of dietary antigens, intestinal permeability and the intestinal inflammatory and immunological response in the pathogenesis and clinical course of the disease. At this point, there is no medical or surgical treatment capable of curing the disease, and the only realistic therapeutic objectives consist of achieving remission of the active phases, treatment of complications, and an attempt to maintain remission with immunosup-pressive agents and more recently with long-term infliximab treatment. Though the obvious aim of artificial nutrition is to improve or restore adequate nutritional status in the presence of malnutrition by artificially administering nitrogen together with an energy source, in Crohn's disease, an increasingly investigated aspect is the assessment of whether or not enteral nutrition (EN) may have the role of primary care.
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