Total parenteral nutrition in the management of inflammatory bowel disease in children: A limited role

Twenty-two children with severe active inflammatory bowel disease were treated with total parenteral nutrition and bowel rest for 2 to 4 weeks in an attempt to induce remission, decrease steroid dependence, stimulate growth and avoid surgical resection. Of 14 patients with Crohn's disease, 9 had complete remission, 4 improved and 1 was unchanged. Eight patíents had recurrence within 3 months and three within 1 year, and two are in remission. Eight patients have required operation within 22 months. Eight children had severe exacerbations of ulcerative colitis (more than 10 bloody stools a day). Four patients did not improve and required total colectomy. Four patients had resolution of symptoms, but two of these had recurrent symptoms at 10 and 11 months. Total parenteral nutrition and bowel rest induce temporary remission or significant improvement of Crohn's disease in most children. The remission is short-lived, however, and most patients have recurrence and require operation within 1 year. A few children have a satisfactory long-term result, but there are no criteria to predict a good response. If an operation is indicated, it should not be deferred in the hope that total parenteral nutrition might provide lasting benefit, although a temporary delay of operation may be of great value in selected patients. Total parenteral nutrition is less effective in ulcerative colitis than in Crohn's disease. Most children who have acute exacerbation of disease and do not respond to bowel rest and intravenous steroids within 1 week should have colectomy. Total parenteral nutrition may be helpful in selected patients, particularly if time is needed to prepare the child for operation, but it does not alter the long-term course of the disease.