Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 23, No. 3, 309-317 (2008)
DOI: 10.1177/0884533608318674

Pivotal Papers

Is There a Role for Bowel Rest in Nutrition Management of Crohn's Disease?

Dawn M. Wiese1, Rene Rivera, MD2 and Douglas L. Seidner, MD3

From 1 Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland;2 Nutrition Support Team, Digestive Diseases Institute, Department of Gastroenterology, Cleveland Clinic, Cleveland; and3 Vanderbilt Center for Human Nutrition and Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Address correspondence to: Dawn Wiese, Department of Gastroenterology, Cleveland Clinic, Cleveland, OH; e-mail: wiesed{at}ccf.org.

In 1988, Greenberg and colleagues published a large randomized controlled trial to address whether bowel rest could lead to improved disease activity in patients with active Crohn's disease. The results of this study provide substantial evidence that bowel rest is not necessary to achieve remission in patients with active Crohn's disease receiving nutrition support. Before this study, great controversy existed about the use of nutrition support and bowel rest in the treatment of active Crohn's disease because of a limited number of conflicting studies providing evidence for and against its application. The results of the publication by Greenberg et al are fundamental because they helped to settle this important argument. Furthermore, this pivotal paper changed the clinical guidelines for the use of nutrition support in the management of active Crohn's disease. Since the publication of this pivotal article, many developments in the field of nutrition and in the treatment of Crohn's disease have helped validate and further its results. Subsequent studies and debate center on the use of enteral nutrition as primary treatment in patients with active Crohn's disease. Data regarding the efficacy, composition, and overall role of adult enteral nutrition in the management of Crohn's disease are presented. This article revisits the Greenberg paper and discusses some of these innovations in nutrition.

Key Words: nutrition • nutrition therapy • enteral nutrition • parenteral nutrition • inflammatory bowel diseases • Crohn's disease


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