Nutritional Therapy

Enteral and the parenteral nutrition are important and effective aspects of the therapy, especially concerning exacerbations and remission induction, malnutrition and complications of CD. Malnutrition is a common factor which affects 25-85% of hospitalised patients, and up to 23% of ambulatory patients. Malnutrition in CD is characterised by protein-caloric depletion as a result of loss of appetite, vomiting, bleeding, compromised digestion and absorption, diarrhoea, increased metabolism, and as a result of starvation as a commonly employed method of treatment at times of disease exacerbations [18]. Malnutrition leads to anaemia, hypoproteinemia, hypoalbu-minemia and vitamin and microelement deficiency.

Total parenteral nutrition used to be a gold standard in the treatment of exacerbated CD. The Green-berg study showed no difference between the polymorphic diet and the total parenteral nutrition method. The authors concluded that the previously recommended "resting of the intestine" has no effect on remission induction [19]. The advantages of early enteric nutrition (tube, orally) are lower costs, less complications, positive impact on intestinal mucosa and an overall nourishment improvement. Early enteric nutrition can induce remission at a level comparable to steroid therapy.

Enteric nutrition is a first-line therapy in the nutritional treatment of CD. It should be started at

3-5 days from the onset of acute symptoms to eliminate malnutrition and malnutrition-associated complications as well as to aid steroid therapy.

Total parenteral nutrition must be reserved for patients who do not tolerate enteric feeding, who are cachectic or present with a kwashiorkor type of malnutrition after resection surgery, and in situations when enteric feeding is not efficient in satisfying calorie requirements [18].

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