Effects of Enteral Nutrition and Corticosteroid on Intestinal Flora in Induction Remission of Crohn Disease in Adult

Study Overview
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Brief Summary
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The pathogenesis of Crohn Disease (CD) is unknown, but there is evidence show that the inadequate immune response or overreaction of the immune system against food antigens or components of the commensal flora involve it. Corticosteroid therapy is effective for adult patients with CD, but it has side effects and can't promote mucosal healing. In recent years, Enteral nutrition (EN) is becoming primary therapy in induction and maintenance remission of CD, especially in children. But the mechanism of EN in induction and maintenance remission of CD is still unclear, and parts of patient have good clinical response to EN therapy while other don't. So we design the study to explore whether EN treats CD by effecting intestinal flora and whether the intestinal flora of patient with CD relates with clinical response.

Detailed Description
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The pathogenesis of CD is unknown, but there is evidence show that the inadequate immune response or overreaction of the immune system against food antigens or components of the commensal flora involve it. Corticosteroid therapy is effective for adult patients with CD, but it has side effects and can't promote mucosal healing. In recent years, EN is becoming primary therapy in induction and maintenance remission of CD, especially in children. But the mechanism of EN in induction and maintenance remission of CD is still unclear, and parts of patient have good clinical response to EN therapy while other don't. So we design the study to explore whether EN treats CD by effecting intestinal flora and whether the intestinal flora of patient with CD relates with clinical response.

Official Title
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A Randomized, Controlled, Single-blind Study of Effects of Enteral Nutrition and Corticosteroid on Intestinal Flora in Induction Remission of Crohn Disease in Adult

Conditions
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Crohn Disease

Intervention / Treatment
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* Dietary Supplement: enteral nutrition
* Drug: corticosteroid


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients should be in the age range of 18 - 75 years; Patients should have clinical, imaging, endoscopic and histological diagnosis of CD based on WHO criteria Patients should have a CDAI score of more than 150 and have a CRP level of more than 10mg/L at enrollment; Patients will not be excluded if they have received 5-ASA(Aminosalicylic acid) or immunomodulator for >8 weeks and the dose is stable Informed consent Exclusion Criteria: Patients who can't tolerate enteral nutrition because of complications, such as complete intestinal obstruction, gastrointestinal perforation or bleeding etc. Patients who receive corticosteroids or enteral nutrition or prebiotics /probiotics/synbiotics/antibiotic treatment in the previous 4 weeks. Patients who accompanied extra-intestinal manifestations, serve complications, and active perianal disease and need other drug therapies. Patients who had ostomy or colectomy or subtotal colectomy Patients with end-stage disease or is expected likely to die during the study Patients are participating in other clinical trials or participated within 6 months prior to this study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: enteral nutrition<br>The patients receive treatment of enteral nutrition only. | Dietary Supplement: enteral nutrition<br>* enteral nutrition only (Nutrison Fibre, 20-30kcal/kg/day)<br>|
| Experimental: Corticosteroid<br>The patients receive treatment of corticosteroid only. | Drug: corticosteroid<br>* corticosteroid(equal dose to prednisone 0.75mg/kg/day,4 weeks)<br>* Other names: hydrocortisone;|
| No Intervention: Healthy control<br>healthy people applied with normal diet. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| change of intestinal flora of stool | Change from baseline in diversity and composition of intestinal flora of stool every week and time point of clinical remission after intervention | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| biochemical indexes | Change from baseline of hematological and biochemical indexes (CRP(C-reactive protein), PCT(procalcitonin), ESR(erythrocyte sedimentation rate), Alb) of blood every week | 6 weeks | 
| CDAI(Crohn's disease activity index) | Change from baseline of CDAI every week | 6 weeks | 
| Fecal Calcium Protein | Change from Baseline in Fecal Calcium Protein in every week | 6 weeks |