Partial Enteral Nutrition Introduction
Partial enteral nutrition (PEN) involves consuming a specific percentage of daily calories in the form of liquid nutrition and filling out the rest of the calories with solid food. Although the use of PEN alongside a standard diet has not been shown to be effective for inducing remission, it may be effective to help maintain remission when used alongside medications. Use of PEN as a part of the Crohn's Disease Exclusion Diet, on the other hand, has been shown to be as effective as Exclusive Enteral Nutrition (EEN) for inducing remission.
At one time, PEN was under consideration as a potential method to maintain remission after EEN. Unfortunately, PEN alone (without medications and used with a standard diet) is not as effective as was originally hoped. Many patients relapse soon after transitioning from EEN to PEN.
However, when PEN is used adjunctively (alongside medications), it can help maintain remission when used in higher amounts (40-50% of the daily caloric intake), even when used alongside a regular diet. Partial enteral nutrition can be especially beneficial alongside biologic medications. Biologics carry a risk of loss of response. Loss of response occurs when a patient who initially responds to a specific treatment stops responding over time. The use of PEN alongside biologics may reduce loss of response to biologics. The ongoing use of PEN may prolong remission, reduce the need for steroids, lead to growth and better nutrition, and be helpful in children experiencing pubertal delay. When considering PEN, work with your medical team and dietitian to calculate the appropriate percentage of daily caloric intake.
Partial Enteral Nutrition and Surgery
Using PEN for two or more weeks prior to surgery to optimize nutrition has been shown to significantly reduce complications after surgery. Use of PEN at 40-50% of the daily caloric intake after surgery has been shown to reduce the likelihood of future surgical resections.
See the Partial Enteral Nutrition page of the NTforIBD website for evidence/citations supporting the use of PEN.