The provision of food is thought to promote the maintenance of gut integrity. Nutrients are able to elicit and affect both systemic and mucosal immune responses. Enteral diet therapy has long been known to be efficacious in inflammatory bowel disease (IBD), particularly in childhood Crohn's disease. However, the mechanisms of action of these diets are not clear. Nutritional repletion, direct effects on the gut mucosa or decreased intestinal permeability have all been postulated as being important in nutritional therapy. There is some evidence that the enteral diet has a direct effect on the gut mucosa by reducing cytokine production and the accompanying inflammation, thus leading to decreased intestinal permeability. Modifications of enteral diet composition have been evaluated in many studies. Such modifications include fat and/or protein content and the addition of bioactive peptides. The fatty acid composition of the enteral diet seems to have a much greater impact on its efficacy than modification of the N source. As specific fatty acids are precursors of inflammatory mediators derived from arachidonic acid, the reduction in these components may be beneficial in nutritional therapy for IBD. Addition of bioactive peptides to enteral diet formulas may also have a role; such peptides may have specific growth factor or anti-inflammatory actions. There is still much work to be done to define disease-specific enteral diet formulas that are effective as therapies for both Crohn's disease and ulcerative colitis.
人们认为,提供食物可以促进肠道完整性的维护。营养物质能够引起并影响全身和粘膜免疫反应。肠内饮食疗法对炎症性肠病(IBD),尤其是儿童克罗恩病(Crohn's disease)的疗效早已众所周知。然而,这些饮食的作用机制尚不清楚。营养补充、对肠道粘膜的直接影响或肠道渗透性的降低都被认为是营养疗法的重要作用。有证据表明,肠内饮食可通过减少细胞因子的产生和伴随的炎症对肠道粘膜产生直接影响,从而降低肠道渗透性。许多研究对肠内饮食成分的调整进行了评估。这些改变包括脂肪和/或蛋白质含量以及添加生物活性肽。与 N 来源的改变相比,肠内饮食的脂肪酸组成对其疗效的影响似乎更大。由于特定脂肪酸是由花生四烯酸衍生的炎症介质的前体,因此减少这些成分可能有利于 IBD 的营养治疗。在肠内饮食配方中添加生物活性肽可能也有一定作用;这类肽可能具有特定的生长因子或抗炎作用。要确定能有效治疗克罗恩病和溃疡性结肠炎的特定疾病肠道饮食配方,还有很多工作要做。