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Enteral Diet for Crohn's Disease

Medically Reviewed by Sabrina Felson, MD on June 19, 2022

Crohn’s disease can make it hard for your gut to absorb enough calories and nutrients for your body to stay healthy.

If this is the case, your doctor may recommend enteral nutrition therapy (ENT). It’s an alternative therapy in which food is supplemented with nutrient-rich drinkable formulas to help you maintain or gain weight. ENT can work for people of all ages, including newborns and children. The goal of this therapy is to ease your symptoms, improve your overall quality of life, and help you absorb key nutrients.

How Does Enteral Nutrition Therapy Work?

Most ENT liquids (Boost, Ensure, and Orgain) contain all the proteins, carbohydrates, fats, minerals, and vitamins that your body needs for proper growth and support. These liquids are also available in different flavors.

The diet can be used to either supplement your daily caloric intake or as a main source of nutrition. You can either drink the liquids or it can be delivered directly into your stomach or gut through a soft, thin feeding tube.

Depending on how serious your Crohn’s symptoms are, the amount of liquid you need to tube-feed or drink may vary. Your doctor may recommend one of two therapies:

Exclusive enteral nutrition (EEN). With this type, you will receive tube feeding for all your meals. This usually includes plain water and other forms of nutrient-rich liquids. According to research, EEN has been found to ease Crohn’s symptoms and stop the disease from acting up.

Partial enteral nutrition (PEN). You will get tube feeding in addition to your regular meals to help you meet your energy needs. This means you might get anywhere from 30% to 50% of daily calories from formula and the rest from solid foods.

How much formula you need will vary from person to person. A licensed dietician or doctor will discuss the right amount of formula you will need.

How Does Enteral Nutrition Therapy Help Crohn’s Disease?

When you’re on ENT, it can change the balance of good and bad bacteria (microbiome) in your gut. This can help reduce the inflammation in your digestive tract as well as ease Crohn’s symptoms such as discomfort, belly pain, and vomiting.

In addition to this, ENT can:

  • Start remission; this means the signs of Crohn’s can begin to fade
  • Heal the lining in your gut
  • Improve nutrition
  • Help you gain weight
  • Increase muscle mass
  • Improve bone health
  • Boost growth, especially in children

Studies show that ENT can be as effective as IBD medications such as steroids to start remission. It’s also safer, as steroids are known to cause serious side effects in the long run. But don’t stop taking your steroid medication without first talking to your doctor about it.

What Are the Different Types of Feeding Tubes?

There are several types of feeding tubes, even though this treatment is often done orally without a tube. Common types include:

Nasogastric tube (NG tube). The tube travels through one side of your nose to your stomach.

Nasoduodenal tube (ND tube) or nasojejunal tube (NJ tube). The tube is placed through your nose down into your small intestine, the part of the gut that absorbs most of the nutrition.

Gastronomy tube (G-tube) or jejunostomy tube (J-tube). The tube is directly inserted into your stomach or gut through a surgical cut in your skin.

How Long Do You Need Enteral Nutrition Therapy?

If ENT is right for you, you will need to follow the tube feeding, or liquid diet, for a short period of time. This is usually around 8-12 weeks. Your doctor may start you on ENT when you first get diagnosed with Crohn’s disease or whenever your symptoms flare up. This is called induction therapy. Throughout this period, you can drink water whenever you feel thirsty.

If you or your child is unable to keep food down or your Crohn’s symptoms become worse, your doctor might keep you on the enteral diet a little longer.

What Happens When You Stop Enteral Nutrition Therapy?

Once your Crohn’s symptoms are under control, your doctor or dietician can help you come up with a meal plan. This will usually include a combination of regular meals with solid foods, formula, medications, and special diets to help you keep the condition at bay. This is called maintenance therapy.

What Are Some of the Challenges?

Getting your timely meals through a feeding tube can be hard to stick to, especially for children and teenagers. ENT is also difficult to follow in certain places like school, work, or at social events and it can disrupt your daily routine. If you choose to drink the formula by mouth, you or your kid might get flavor “burnout” because of the lack of variety. This can hurt your appetite.

To beat the boredom, try different flavors or formulas. In some cases, your doctor may allow you to suck on hard peppermint candy to spruce up your tastebuds. If you or your child is having a hard time following the strict diet, discuss your options with a doctor and come up with a plan that works best for you.

What Are the Possible Risks With Enteral Nutrition Therapy?

ENT is generally safe. But sticking to a liquid diet through a feeding tube could cause some complications, such as:

  • Constipation
  • Dehydration
  • Diarrhea
  • Skin Issues, especially around the site where the tube enters your body
  • Unintended tears in your gut (perforation)
  • Infection in your abdomen (peritonitis)
  • Blockages in the feeding tube

Since the ENT diet is mostly liquids, you or your child might be at risk for malnourishment due to:

  • Lack of appetite
  • Not getting enough calories
  • Poor digestion and nutrient absorption in the gut

In rare cases, this malnutrition can cause the fluids and electrolytes in your body to be out of balance and lead to a condition called “refeeding syndrome.”

This can cause serious side effects such as:

If you notice this, let your doctor know immediately. In case of an emergency, call 911 or head to the nearest hospital.

What’s the Outlook?

ENT is generally a safe, low-risk therapy. It’s also a minimally invasive procedure to place the tube inside your body. Tubes are typically only used in adults when hospitalized. Research shows that it’s especially effective among children with Crohn’s and leads to remission in about 80% of the cases. It’s also a good treatment option if you’re planning to cut back or adjust your steroid dosage.

If you’re planning to give ENT a try, talk to your doctor about whether it’s the right fit for you.

Show Sources

SOURCES:

American Society for Parenteral and Enteral Nutrition: “What Is Enteral Nutrition.”

Boston Children’s Hospital: “What Is Exclusive Enteral Nutrition?”

Crohn’s & Colitis Foundation: “Nutritional Support Therapy.”

Nemours Kid’s Health: “Nutrition Therapy and Crohn's Disease.”

Nutrients: “Enteral Nutrition in Adult Crohn’s Disease: Toward a Paradigm Shift.”

Stanford Health Care: “Enteral Nutrition Therapy.”

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