Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease.

Background and Aim: Exclusive enteral nutrition (EEN) is emerging as a therapeutic option for adults with Crohn's disease (CD). However, there is no standardized approach to delivering this therapy. The aim of this study is to develop an optimal care pathway for using EEN in adults with CD. This will create a standard of care against which to benchmark practice and provide direction for future research. Method(s): A working group of 12 multidisciplinary inflammatory bowel disease specialists from Australia and New Zealand was convened to develop a practical, clinically focused care pathway for using EEN in adults with active CD. Six key areas were identified as part of the care pathway: clinical indications, nutrition assessment, EEN protocol, EEN monitoring, accessing formula, and food reintroduction. Current literature was identified via systematic review, and quality of evidence was graded. Consensus expert opinion was used where literature gaps were identified. Result(s): An optimal care pathway for using EEN in adults with CD was developed (Fig. 1), with six key consensus statements informing how to use EEN in adults with active CD. These key statements identify clinical indications for use, nutrition assessment and prescription, duration of therapy, monitoring criteria, food reintroduction, and the role of partial EEN. An accompanying patient resource was also developed. Conclusion(s): EEN is recommended as a treatment option for inducing remission in adults with active CD. The consensus statements developed are practical and based on best available evidence and expert opinion to assist in a standardized approach to delivering EEN therapy.