Crohn's Disease

Question 1

Clinical features

Answer 1

Diarrhoea
Abdo pain
Anorexia
Fever
Intestinal obstruction

Question 2

Complications

Answer 2

Fistulae
Obstruction
Strictures
Ulcers
Haemorrhage

Question 3

40% occur

Answer 3

In ileocecal region

Question 4

Surgical management

Answer 4

Take out diseased part but disease is not gone

Less GI tract for nutrient absorption

Question 5

Surgical management:

Strictureplasty

Answer 5

Opens up narrowings of the bowel

Question 6

Surgical management:

Resection

Answer 6

Part of small bowel removed

Proctocolectomy

Question 7

Dietary management:

Child energy req

Answer 7

500-1400kcal higher than normal

Question 8

Dietary management:

In those with strictures + obstructive symptoms

Answer 8

Diet with adapted texture or distal enteral nutrition

Question 9

Benefits of nutrition support

Answer 9

Bowel rest
Social effects
Immunological effects
Intestinal adaptation

Question 10

Exclusive enteral nutrition

Answer 10

Associated with 60-80% remission rate

Can decrease local + systemic inflammation

Promote weight gain

Question 11

Exclusive enteral nutrition:

Modulen IBD

Answer 11

Nestle
Contains TGF-B2
Whole protein powder
Can be conc to 1.5kcal/ml
Oral or tube feeding
Can be flavoured

Question 12

Exclusive enteral nutrition:

Supplementary

Answer 12

Overnight feeding
Oral supplements
Significant short-term benefits

Question 13

Exclusive enteral nutrition:

Common feed related problems

Answer 13

Hunger
Nausea
Unable to manage feed volumes
Diarrhoea
School/social disruption

Question 14

Exclusive enteral nutrition:

Forbes ESPEN guidelines

Answer 14

First line to induce remission in children + adolescents with active CD

Question 15

Enteral nutrition as primary therapy

Cochrane review

Answer 15

Less effective than conventional corticosteroid therapy

Question 16

Enteral nutrition as primary therapy:

Benefits

Answer 16

Improves nutritional status

Fewer side effects

Question 17

Elemental vs polymeric

Answer 17

Cochrane systematic review - no significant difference in efficacy

Elemental limitations - taste, quantity, nausea, osmotic diarrhoea

Question 18

Exclusion diets

Answer 18

Not recommended to achieve remission in active CD

Question 19

Food reintroduction:

LOFFLEX

Answer 19

Low fat, fibre limited exclusion diet
Based on foods less likely to cause intolerance
Fat ~50g/d and fibre ~10NSP/d

A: speeds up reintroduction process (takes ~2-4wk)

Allowed - lean meat, soya milk, sunflower/olive oil, sugar/honey/jam

Question 20

Pre-, pro- and synbiotics

Answer 20

No strong evidence of effectiveness of pre or pro biotics

Synbiotics show some potential but confirmatory evidence required