While Exclusive Enteral Nutrition (EEN) is a first-line treatment for Crohn’s disease in a paediatric setting, it is used less frequently in adults. To learn more about EEN in adults, DC’s Jane Winter sat down with Advanced APD and Advanced Gastroenterology and ICU Team Leader, Liz Purcell. In the podcast, Liz pinpoints who is most likely to benefit from EEN, the considerations for a potential EEN patient and the key factors influencing treatment compliance. Liz also offers her top tips for encouraging patients to trial EEN and, subsequently, how she empowers these patients to improve their health outcomes and quality of life.
Biography
Liz Purcell is an Advanced Accredited Practicing Dietitian, with more than 20 years’ experience. Throughout her career, Liz has developed extensive clinical expertise in a range of practice domains and across the continuum of care but harbors a particular interest and has advanced clinical knowledge in Gastroenterology – specifically Inflammatory Bowel Disease – and Intensive Care nutrition.
Over the past few years, Liz has represented her profession nationally and internationally, contributing towards the development of National Guidelines, Australian Standards and Action plans, while committing to her primary role as Advanced Gastroenterology and ICU Team Leader within Metro South Health. Liz is currently undertaking research in the area of Exclusive Enteral Nutrition in the management of adults with Crohn’s Disease.
In this episode, we discuss:
- How the multidisciplinary team and patient decide if EEN is suitable
- Common EEN issues and how to troubleshoot them
- Strategies to improve compliance to EEN
- The typical goals that are established by a patient before starting EEN
- What dietitians need to consider when choosing an EEN formula
- Dietetic assessment, monitoring and evaluation
- The process of ending treatment and reintroducing an unrestricted diet
Additional resources
Patient resource – EEN for Crohn’s disease
References
1. Day A, Wood J, Melton S, Bryant R. Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn’s disease. JGH Open. 2019;0(0).
2. The Royal Children’s Hospital M. The Hierarchy of Evidence Melbourne2014 [cited 2018 5 October]. Available from: https://www.rch.org.au/uploadedFiles/Main/Content/rchcpg/hospital_clinical_guideline_in dex/Hierarchy%20of%20Evidence%20holter%20monitor.pdf.
3. Heerasing N, Thompson B, Hendy P, Heap GA, Walker G, Bethune R, et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn’s disease. Aliment Pharmacol Ther. 2017;45(5):660-9.
4. Voitk AJ, Echave V, Feller JH, Brown RA, Gurd FN. Experience With Elemental Diet in the Treatment of Inflammatory Bowel Disease: Is This Primary Therapy? JAMA Surgery. 1973;107(2):329-33.
5. Rocchio MA, Cha C-JM, Haas KF, Randall HT. Use of chemically defined diets in the management of patients with acute inflammatory bowel disease. The American Journal of Surgery. 1974;127(4):469-75.
6. Torres J, Mehandru S, Colombel J-F, Peyrin-Biroulet L. Crohn’s disease. The Lancet. 2017;389(10080):1741-55.
7. Levine A, Wine E, Assa A, Sigall Boneh R, Shaoul R, Kori M, et al. Crohn’s Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology. 2019;157(2):440-50 e8.
8. Tena Niseteo et al. Modified Crohn’s disease exclusion diet is equally effective as exclusive enteral nutrition: Real-world data. Nutr. Clin. Pract. 2021;1–7
This podcast is not, and is not intended to be, medical advice, which should be tailored to your individual circumstances. This podcast is for your information only, and we advise that you exercise your own judgment before deciding to use the information provided. Professional medical advice should be obtained before taking action. Please see here for terms and conditions.
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