Exclusive enteral nutrition enhances corticosteroid response in severe ulcerative colitis

In patients with acute severe ulcerative colitis (ASUC), week-long treatment with exclusive enteral nutrition (EEN) helps boost response to corticosteroid, a study has found.

In total, 62 ASUC patients (mean age, 35.3 years; 40 percent male) were randomized to receive EEN (n=32) or standard of care (SOC; n=30). Those on EEN were given a semi‐elemental formula for 7 days in addition to SOC.

EEN efficacy was evaluated by corticosteroid failure, defined as the need for salvage medical therapy or colectomy. Some patients underwent a faecal microbial analysis on day 1 and day 7 using 16s ribosomal RNA sequencing.

Significantly fewer patients in the EEN group versus the SOC group failed corticosteroid treatment (intention‐to‐treat analysis: 25 percent vs 43 percent; p=0.051; per-protocol analysis: 19 percent vs 43 percent; p=0.04). However, there was no difference in the number of those who underwent colectomy (9 percent vs 13 percent; p=0.41).

Other endpoints were also more favourable in the EEN group. They had a shorter hospital stay (median, 10 vs 13 days; p=0.04), higher day 7 albumin level (mean, 34 vs 29 g/L; p<0.01), greater decline in serum C‐reactive protein and faecal calprotectin levels (p=0.04 for both), and a lower composite outcome of colectomy/hospitalization at 6 months (16 percent vs 39 percent; p=0.045) relative to patients in the SOC group.

Furthermore, EEN was associated with an increased abundance of Erysipelotrichaceae at day 7, with reduced Bifidobacterium and Veillonellaceae compared with SOC.