Exclusive enteral nutrition for induction of remission in Crohn's disease in adults: A systematic review and meta-analysis of randomized trials and real-world studies.

Abstract / Summary

Exclusive enteral nutrition (EEN) is an established induction therapy in pediatric Crohn's disease (CD); however, its role in adults remains less well defined. A systematic search was performed through December 2025. Eligible studies included randomized controlled trials (RCTs) and non-randomized studies evaluating EEN in adults (≥ 18 years) with active CD. The primary outcome was clinical remission, defined by validated disease activity indices. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale. Random-effects models were applied to estimate pooled remission rates and relative risks. Forty studies, comprising 2459 patients, were included. In 23 real-world cohort studies (n = 1269), the pooled clinical remission rate with EEN was 66% (95% CI = 0.60-0.71, I2 = 69.9%, p < 0.0001). In five RCTs (n = 315) comparing corticosteroids with EEN, corticosteroids achieved higher remission rates compared with EEN (RR 0.65, 95% CI = 0.50-0.84; p = 0.0009). In eight RCTs (n = 301), remission rates did not differ significantly between elemental and non-elemental formulations (RR 1.04, 95% CI = 0.88-1.23). Sub-group analyses by protein type and lipid composition showed no differences in efficacy. In two studies, combination therapy with biologics plus EEN was associated with a higher clinical remission compared with biologics alone (RR 0.75; 95% CI = 0.67-0.84; p < 0.0001). Adverse events were generally mild, with poor palatability being most frequent. EEN induces clinical remission in adults with CD. It is less efficacious than corticosteroids to induce clinical remission. The efficacy of EEN is independent of formula composition. Given its favorable safety profile, EEN may represent a therapeutic option in select adult patients. PROSPERO registration number: CRD42023445039.

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