Letter: Exclusive Enteral Nutrition in Ulcerative Colitis—The Path Ahead Needs Careful Consideration

Alimentary Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

We read with interest the recent article by Chu et al. Meta-Analysis: Exclusive Enteral Nutrition in Adults With Ulcerative Colitis [1], which addresses unresolved question of efficacy exclusive enteral nutrition (EEN) management ulcerative colitis (UC). Preclinical studies have previously demonstrated a significant reduction colonic inflammation when using elemental diets animal models mimicking UC [2]. However, these findings seldom been replicated human trials compared Crohn's disease (CD), where EEN is an established therapy. These limitations may be due, part, to existing combining patients CD and UC, despite pathophysiological differences between conditions [3]. This heterogeneity can obscure disease-specific effects EEN, particularly UC. Furthermore, published largely included cohorts moderate-to-severe acute severe or refractory corticosteroids. represent populations burden, on those milder activity has not clearly established. Additionally, there duration (often 7–14 days treatment 6–12 weeks CD), follow-up time primary endpoints studies. Thus, it unsurprising that positive sparsely seen literature date. As noted faecal calprotectin appears reduce after 7 raises as whether we expect meaningful therapeutic responses longer therapy most modern IBD assess at 26 52 weeks. adjunctive role expanding armamentarium advanced therapies available for fully Future should carefully consider appropriate timepoints important outcomes, evaluate combination clinical, biochemical, sonographic endoscopic gain more nuanced understanding utility The unique composition also warrants consideration Standard formulas are fibre-free, known implications gut microbiota promote dysbiotic microbial environment [4]. A deeper mechanism action therefore how contributes CD-related inflammation, would further progress our Resistant starch, fructooligosaccharide non-starch polysaccharide shown some beneficial previous [5], therefore, mechanistic fibre-free vs. fibre-containing potentially optimise benefit In conclusion, applaud authors advancing conversation To truly understand its role, future must address designing stratify type, durations therapy, adopt explore impact formula efficacy. Such efforts critical determine similarly use CD. Sarah Melton: conceptualization, writing – original draft, review editing. Akhilesh Swaminathan: Jessica Fitzpatrick: nothing report. declare no conflicts interest. linked al papers. view articles, visit https://doi.org/10.1111/apt.18495 https://doi.org/10.1111/apt.70121.

Language: Английский

Letter: Exclusive Enteral Nutrition in Ulcerative Colitis—The Path Ahead Needs Careful Consideration. Authors' Reply

Alimentary Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский