Efficacy and tolerability of short-course exclusive enteral nutrition as an adjunct to standard therapy in patients with acute severe ulcerative colitis

Abstract

Background and Aim: Acute severe ulcerative colitis (ASUC) occurs in about 15–25% of patients with ulcerative colitis (UC). Intravenous corticosteroids remain the first-line therapy. However, about 30% of patients fail to respond to corticosteroids and will require medical rescue therapy or colectomy.1 A recent randomized controlled trial suggested that the adjunctive use of short-course exclusive enteral nutrition (EEN) for a period of 7 days in patients with ASUC was associated with lower rates of steroid failure compared with standard care.2 We aimed to determine the efficacy and tolerability of short-course EEN as an adjunct to standard therapy in our local cohort of patients with ASUC. Methods: We performed a retrospective analysis of patients presenting with ASUC, diagnosed using the Truelove and Witts criteria, who were treated with short-course EEN in addition to standard care between June 2022 and March 2023. Data collection included age, sex, distribution of UC, prior use of biologic agent, endoscopic Mayo score, fecal calprotectin level on admission, number requiring infliximab rescue therapy on Day 3, and number proceeding to colectomy during index admission. Outcome measures were tolerability of short-course EEN and its efficacy in preventing steroid failure, as defined by the Oxford criteria. Patients who declined EEN were excluded. Results: Fifteen patients were included in our study. The median age was 32 years (range, 18–78 years), and 60% were male. Most patients (73.3%) had pancolonic UC, with 26.7% already using a biologic agent. Eleven of the 15 patients had flexible sigmoidoscopy during admission, while three had colonoscopies within 1 week before presentation. One patient did not have an endoscopic assessment due to active COVID-19 infection. Half (53.3%) had an endoscopic Mayo score of 3, with 40% having an endoscopic Mayo score of 2. The median fecal calprotectin level on admission was 2300 μg/g (range, 240–7600 μg/g). Thirteen of 15 patients (86.7%) completed 7 days of EEN. One patient declined to continue EEN, and one discontinued due to vomiting, both on Day 3. Corticosteroid failures were recorded for two of 15 patients (13.3%), who required infliximab rescue therapy. Both had completed 7 days of EEN. No patient required colectomy. Conclusion: Our data indicate that short-course EEN in addition to standard care for these patients presenting with ASUC had a high degree of tolerability (86.7%) and lower rates of steroid failure than reported in the literature (13.3% vs 30%). A more robust prospective randomized controlled trial is required to further characterize the efficacy of EEN in patients with ASUC, as well as to determine optimal duration of therapy.No Full Tex