Crohn's Disease: The Role of Nutrition Support

Donald R. Duerksen, MD, St. Boniface General Hospital and University of Manitoba, Winnipeg, Manitoba, Canada.

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In This Article

Specialized Nutrients

Glutamine

Glutamine, a conditionally essential amino acid, is the preferred fuel of the small bowel and may also have a role in regulating intestinal permeability.[41] Defects in intestinal permeability may be important in the pathogenesis of Crohn's disease.[42] Therefore, there may be a role for glutamine supplementation in the management of acute Crohn's disease. A recent study of Crohn's disease in patients with intestinal permeability defects randomized to receive either 21 g of supplemental oral glutamine or placebo for 4 weeks reported no improvement in permeability, CDAI, or nutritional status.[43] Further studies are therefore needed to assess whether there is any role for supplemental glutamine in the management of Crohn's disease.

Omega 3 Fatty Acids

The use of omega 3 fatty acids has been advocated in a variety of chronic inflammatory diseases because of the anti-inflammatory effects they exert through several potential mechanisms: reduced production of leukotriene B4 and thromboxane A2, inhibition of inflammatory cytokines such as interleukin-1 and tumor necrosis factor, and scavenging of free radicals[44] Several small clinical studies have demonstrated clinical benefit with use of these agents in patients with Crohn's disease. Specifically, Belluzzi and colleagues[45] demonstrated that after 1 year of treatment with 2.7 g of enteric-coated omega 3 fatty acids, 59% of patients remained in remission compared with 26% on placebo.[45]

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