Introduction Exclusive enteral nutrition (EEN) is a well-established induction therapy in pediatric Crohn’s disease, where it offers anti-inflammatory efficacy while avoiding corticosteroid-related toxicity. In adults, however, EEN has been less widely adopted because of concerns regarding adherence, palatability and uncertain comparative effectiveness relative to standard medical therapy.
Introduction
Exclusive enteral nutrition (EEN) is a well-established induction therapy in pediatric Crohn’s disease, where it offers anti-inflammatory efficacy while avoiding corticosteroid-related toxicity. In adults, however, EEN has been less widely adopted because of concerns regarding adherence, palatability and uncertain comparative effectiveness relative to standard medical therapy.
Problem Statement
The role of EEN in adult Crohn’s disease remains poorly defined due to heterogeneous study designs, variable nutritional formulations and inconsistent remission outcomes across clinical trials. Whether EEN can serve as a practical steroid-sparing strategy in adults—and in which clinical settings it may be most useful—has remained an important unresolved question in inflammatory bowel disease management.
Summary
This systematic review and meta-analysis demonstrates that EEN can induce clinical remission in adults with active Crohn’s disease, although its efficacy appears inferior to corticosteroids for remission induction. Across real-world studies, approximately two-thirds of patients achieved remission with EEN, supporting its meaningful anti-inflammatory potential in selected adult populations. Importantly, the analysis found no significant difference in efficacy between elemental and non-elemental formulations, suggesting that therapeutic benefit is independent of formula composition and allowing greater flexibility in nutritional strategy. The review also highlights emerging evidence supporting combination therapy, where EEN used alongside biologics may improve remission outcomes compared with biologic therapy alone. Adverse events were generally mild, with poor palatability remaining the principal limitation affecting tolerability and adherence. These findings reinforce that while EEN is unlikely to replace corticosteroids as first-line induction therapy in most adults, it remains an important steroid-sparing and nutritionally supportive option, particularly in patients where corticosteroid avoidance is desirable or adjunctive nutritional therapy is clinically beneficial. The study supports a more individualized role for EEN within modern adult Crohn’s disease management.
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