ENF References and Abstracts
Home enteral nutrition with formula diets.
Author Russell RI Source Z Gastroenterol, 23 Suppl:1985 Aug, 94-7
Abstract Home enteral nutrition can be successfully used on a long-term
basis to maintain nutrition and a reasonably normal lifestyle in patients with
chronic intestinal dysfunction. Patients can be easily taught the methods
involved, a nocturnal regime allowing a more normal lifestyle. The use of a
pump-controlled system is recommended. Side-effects are few, generally transient
and not severe. Home enteral nutrition has advantages over home intravenous
feeding with respect to ease of administration and organization, fewer and less
severe complications, and cost.
Elemental diets in the prophylaxis and therapy for intestinal
lesions: an update.
Author Bounous G Address Department of Surgery, Montreal General Hospital, Quebec, Canada. Source Surgery, 105: 5, 1989 May, 571-5
The recognition of potentially noxious physiologic substances in
the intestinal milieu prompted the use of an "elemental" semihydrolyzed formula
diet in the prophylaxis of experimental acute ischemic enteropathy. Elemental
diets have been used in the management of a variety of digestive diseases. An
elemental diet protects the intestinal mucosa of rodents from radiation injury
and facilitates mucosal healing. Clinical trials have shown the benefits of this
form of treatment in the prevention of acute radiation enteropathy and in the
therapy for delayed radiation enteropathy and Crohn's disease.
Elemental diet as primary treatment of acute Crohn's disease: a
controlled trial.
Author O'Moron C; Segal AW; Levi AJ Source Br Med J (Clin Res Ed), 288: 6434, 1984 Jun 23, 1859-62
Abstract Acute exacerbations of Crohn's disease are usually treated with
prednisolone or potentially more toxic immunosuppressive drugs or by surgery. In
pilot studies replacing the normal diet by a protein free elemental diet also
induced remission. A controlled trial was therefore conducted in which 21
patients acutely ill with exacerbations of Crohn's disease were randomised to
receive either prednisolone 0.75 mg/kg/day or an elemental diet (Vivonex) for
four weeks. Assessment at four and 12 weeks showed that the patients treated
with the elemental diet had improved as much as and by some criteria more than
the steroid treated group. Elemental diet is a safe and effective treatment for
acute Crohn's disease.
The effect of an elemental diet with and without gluten on
disease activity in dermatitis herpetiformis
Author Kadunce DP; McMurry MP; Avots-Avotins A; Chandler JP; Meyer LJ; Zone
JJ Source J Invest Dermatol, 1991 Aug, 97:2, 175-82
Elemental diets are reported to decrease activity of patients with
dermatitis herpetiformis. We tested the hypothesis that gluten, given in
addition to an elemental diet, is responsible for the intestinal abnormalities,
cutaneous immunoreactant deposition, and skin disease activity in dermatitis
herpetiformis. At entry eight patients with dermatitis herpetiformis, who were
consuming unrestricted diets, were stabilized on their suppressive medications
at dosage levels that allowed individual lesions to erupt. Six patients were
then given an elemental diet plus 30 of gluten for 2 weeks, followed by the
elemental diet alone for 2 weeks. Conversely, two patients received an elemental
diet alone for 2 weeks followed by an elemental diet plus gluten during the
final 2 weeks. Small bowel biopsies, skin biopsies, and clinical assessments
were done at 0, 2, and 4 weeks. Suppressive medication dose requirement
decreased over the 4 weeks by a mean of 66%. Six of eight subjects significantly
improved clinically during the gluten-challenge phase of the elemental diet and
all were improved at the end of the study. The amount of IgA in perilesional
skin did not change significantly, but the amount of C3 increased in five of
seven evaluable subjects after gluten challenge. Circulating anti-gluten and
anti-endomysial antibodies were not significantly affected by the diets. All
subjects completing evaluable small bowel biopsies (seven of seven) demonstrated
worsening of their villus architecture (by scanning electron microscopy and
intraepithelial lymphocyte counts) during gluten challenge and improvement (six
of six subjects) after 2 weeks of elemental dietary intake. We conclude that 1)
there is a significant improvement in clinical disease activity on an elemental
diet, independent of gluten administration, 2) small bowel morphology improves
rapidly on an elemental diet, and 3) complement deposition but neither IgA
deposition nor circulating antibody levels correlate with gluten intake. It
seems likely that dietary factors other than gluten are important in the
pathogenesis of the skin lesions in dermatitis herpetiformis.
Ten years' experience with an elemental diet in the management
of Crohn's disease.
Author Teahon K; Bjarnason I; Pearson M; Levi AJ Address Section of Gastroenterology, MRC Clinical Research Centre, Harrow,
Middlesex, UK. Source Gut, 31: 10, 1990 Oct, 1133-7
Abstract The immediate and long-term outcome of treating patients with acute
Crohn's disease with an elemental diet was studied retrospectively. Successful
diet induced remission was achieved in 96 of 113 patients (85%) regardless of
age, sex, site or severity of disease, or associated complications of
strictures, fistula, or perianal disease. Treatment was unsuccessful in 17
patients (15%), but there were no features at the outset of treatment that
distinguished these patients from those who had successful remission. The
longterm outcome of treatment was assessed over a five year period by analysis
of life tables and survival curves. Twenty two per cent of the patients relapsed
within six months of treatment and thereafter the annual relapse rate was 8-10%.
Patients with disease complicated by fistula or perianal involvement had early
relapse, approaching 100% for the latter. A further retrospective comparison of
longterm outcome of diet vs steroid induced remissions showed no significant
difference in the relapse rates between the two groups at one, three, and five
years.
Dermatitis herpetiformis: consequences of elemental diet.
Author Zeedijk N; van der Meer JB; Poen H; van der Putte SC Source Acta Derm
Venereol, 1986, 66:4, 316-20
The administration of an Elemental Diet to 5 patients with
dermatitis herpetiformis, requiring high doses of Dapsone
(diaminodiphenylsulfone, DDS), showed a rapid and beneficial effect on the skin
lesions within two weeks. This effect was not influenced by simultaneous gluten
challenge in one patient. A possible explanation is a reduction in the amount of
harmful immune complexes due to the elimination of proteins from the diet.
Subsequent introduction of a more comprehensive diet led to an increase of the
minimal effective dose of Dapsone. These results underline the importance of
dietary influences on the skin activity in dermatitis herpetiformis, other than
gluten alone.
Elemental diet in the management of Crohn's disease during
pregnancy.
Author Teahon K; Pearson M; Levi AJ; Bjarnason I Address Section of Gastroenterology, MRC Clinical Research Centre,
Middlesex. Source Gut, 32: 9, 1991 Sep, 1079-81
Abstract Four patients with Crohn's disease were treated with an elemental
diet during pregnancy. Two had active disease and two also had symptoms of small
intestinal obstruction. All went into a clinical remission within a few days of
starting treatment. Treatment periods varied from two to four weeks, and were
followed by elemental diet as a supplement to normal food in two patients. At
term, all delivered a healthy infant. These patients indicate that elemental
diet is a safe form of treatment for Crohn's disease during pregnancy and may be
considered as an alternative to conventional drug treatments which carry a
theoretical risk of teratogenesis.
Oro-facial granulomatosis. Response to elemental diet and
provocation by food additives.
Author Sweatman MC; Tasker R; Warner JO; Ferguson MM; Mitchell DN Clin Allergy, 16: 4, 1986 Jul, 331-8
We report the case of an 8.5-year-old girl with oro-facial
granulomatosis associated with clinical atopy, in whom relapse of her
granulomatous disorder was shown to be related to exposure to specific food
additives, viz. carmoisine, sunset yellow and monosodium glutamate. Treatment
with a restricted diet resulted in considerable regression in the facial
swelling which has been maintained for 6 months. A brief account of the
histological features, both under light and electron microscopy, is given,
together with a description of the use of nuclear magnetic resonance scanning in
the assessment of this disease. The patient had no evidence to support a
diagnosis of sarcoidosis or Crohn's disease.
Pioneering Studies leading to Elemental Nutrient Formulas
Winitz M., et al Evaluation of chemical diets as nutrition for man-in-space.
Nature 1965, 4973; 741-743
Young DS, Epley JA, Goldman P. Influence of a
chemically defined diet on the composition of serum and urine. Clin Chem
1971;17-8:765-773
Perrault J . et al Effects of an elemental diet in healthy volunteers.
Gastroenterology 64:569-576 1973
Winitz W. At al Studies in metabolic nutrition employing chemically defined
diets Am Jour Clin Nutr 23;5, 1970 525-545 and Effects on Gut Microflora ibid
546-559
Voigt AJ, Echave V, Feller JH, et al. Experience with elemental diet in the
treatment of inflammatory bowel disease. Is this primary therapy? Arch Surg
1973;107:329-33
Russell R.I Progress Report Elemental Diets. Gut 1975,16; 68-79
Morin Cl et al Continuous elemental enteral alimentation in the treatment of
children and adolescents with Chron's disease. J Parent Nutr 1982;6:194-199
Russell Robin I Elemental Diets. CRC Press Inc. Boca Raton Florida 1981
Rocchio M.A., Cha C.M., Haas K.F., Randall H.T. Use of chemically defined
diets in the management of patients with acute inflammatory bowel disease. Am.
Jour. Surgery 1974,127:471-475.
O'Morain C, Segal AW, Levi AJ et al Elemental diet as a primary treatment of
acute Crohn's Disease; a controlled trial. Br. Med J 1984:288:1859-62
Frieri et al. Preliminary investigation on humoral and cellular immune
responses to selected food proteins in patients with Crohn's disease. Ann
Allergy 1990;64:345-351
Jones VA, Workman E, Freeman AH et al. Chron's Disease: Maintenance of
Remission by Diet
Villaveces J.W., Heiner D.C. Experience with an Elemental Diet. Annals of
Allergy Dec. 1985, 55: 783-787.
Hill D.J., Lynch B. Elemental diet in the management of severe eczema in
childhood. Clin. Allergy 1982;12: 312-315.
Lucio A. et al Food hypersensitivity and Atopic dermatitis. Allergy 1989; 44
(suppl.9) 140-146.
Osterballe H.O, Bundgaard B., Weeke B., Weiss, M. Double-blind controlled
trial of Elemental Diet in severe, perennial asthma. Allergy 1981,36:257-262
Hughes E.C., Gott P.S., Weinstein R.C. Binggeli R. Migraine: a diagnostic
test for etiology of food sensitivity Annals of Allergy, 1985, 55; 28-32.
Saverymuttu S., Hodgson H.J. F., Chadwick V.S. Controlled Trial comparing
prednisolone with an elemental diet plus non-absorbable antibiotics in active
Crohn's disease. Gut,1985, 26; 994-998
Belli DC, Seidman A, Bouthillier L, et al. Chronic intermittent elemental
diet improves growth failure in children with Crohn's disease. Gastroenterology
1988; 94:A37
O'Morain C, Segal AW, Levi AJ et al Elemental diet as a primary treatment of
acute Chron's Disease; a controlled trial. Br. Med J 1984:288:1859-62
Workman EM, Jones AJ, Hunter JG. Diet in the Managment of Crohn's Disease.
Human Nutr.1984:38A:469-473
Teahon K., Bjarnason I., Pearson A.J., Levi A.J. Ten years experience with an
elemental diet in the management of Crohn's diease. Gut,1990,31;1133-1137
Knicker W. Non-IgE Mediated and Delayed Adverse reactions to Food or
Additives. Handbook on Food Allergies, Ed Breneman J.C.; Marcel Dekker Inc. N.Y.
1985.
Brostoff J. Mechanisms: Food Allergy and Intolerance; Balliere Tinbdal; 1987
Gardner MLG. Evidence for, and Implications of, Passage of Intact Peptides
Across the Intestinal Mucosa. 1983 Biochem. Soc Trans 11; 813
Reinhardt M.C. Macromolecular Absorption of Food Antigens in Health and
Disease. 1984 Ann Allergy.53.597-601
McNeish, A.S.Enzymatic Maturation of the Gastrointestinal Tract and its
Relevance to Food Allergy and Intolerance in Infancy. 1984 Ann Allergy 53: 643
Lucio A. et al Food hypersensitivity and Atopic dermatitis. Allergy 1989; 44
(suppl.9) 140-146.
Nsouli TM et al Role Of Food Allergy In Serous Otits Media. Ann Allergy
1994;73:215-219
Wraith D.G. Asthma in Food Allergy and Intolerance. Brostoff and Challicombe
ed. 486-497; 1987.
Osterballe H.O, Bundgaard B., Weeke B., Weiss, M. Double-blind controlled
trial of Elemental Diet in severe, perennial asthma. Allergy 1981,36:257-262
Vincent J. Avoidance therapy: time-tested methods to treat asthma. Fam. Prac.
Recert. 1990; 12(11): 71-87.
Hughes E.C., Gott P.S., Weinstein R.C. Binggeli R. Migraine: a diagnostic
test for etiology of food sensitivity Annals of Allergy, 1985, 55; 28-32.
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