Advice after your nerve block for surgery
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Introduction
Exclusive Enteral Nutrition (EEN) involves the consumption of oral nutritional supplement (ONS) drinks as the sole source of nutrition to meet all your nutritional needs. It is often commenced as a therapeutic management of
Crohn’s Disease and its aim is to improve your nutritional status whilst providing your gastrointestinal tract a period of rest to allow for healing and reduction in inflammation.
Why have I been recommended to start EEN?
You may have been recommended EEN as part of your medical management for Crohn’s Disease. Reasons for recommending EEN include aiming to induce remission alongside medical therapy or where there is a gap in medical management. It may also be recommended pre-operatively in order to improve post-operative outcomes.
What are the benefits of EEN?
There is evidence to support the role of EEN as an effective treatment to improve symptoms caused of active Crohn’s Disease and induce remission in some patients. It has been shown to offer similar remission rates to corticosteroids with reduced side effects.
Further benefits of EEN include:
- Reducing inflammation in the gastrointestinal tract.
- Providing a period of gut rest by limiting any potential food irritants.
- Promoting mucosal healing within the gut.
- Improving gastrointestinal symptoms such as pain and diarrhoea.
- Improve nutritional status.
- Can help reduce post-operative outcomes where surgery is required.
What does it involve?
EEN is usually recommended for 6-8 weeks, as research suggests this is how long it takes to achieve mucosal healing and reduce inflammation in your gut. This varies from person to person and so some may require shorter or longer courses.
What to expect?
At the beginning of your trial, you will be given a variety of nutritional supplement drinks including milk-style or juice-style supplements. Your dietitian will be able to guide you on the differences between these choices.
Once you start, your supplements will be taken as your sole source of nutrition, and so it is important to try a variety of flavours to help aid compliance.
Your dietitian will discuss the options of supplements & also tell you how
much you need to take to meet your nutritional needs. You will also have the
support of your IBD nurses & gastroenterologist, who will help to manage
any symptoms.
What else can I eat or drink?
Nutritional supplements should be the sole source of your nutrition. However,
during the treatment period you can also have non-nutritive items such as:
- Water
- Clear soups/broths (stock cube mixed with water)
- Diluted sugar free squash
- Fruit or herbal or decaffeinated tea (no milk)
- Bovril drinks
- Boiled sweets / mints (sugar free)
- Chewing gum
Our top tips whilst on EEN:
- The drinks are more palatable when chilled, therefore try to keep them refrigerated.
- Supplements can be frozen and eaten as ice lollies or ice cream/sorbet.
- Milk based supplements can be gently heated and consumed as a warm drink (DO NOT boil as it will alter the vitamins and minerals composition).
- Crushed ice can be added to a blender with supplements for a change in texture.
- Consume drinks slowly over 20 minutes to prevent feeling nauseous or sick.
- Clean your mouth regularly to keep your mouth feeling fresh.
- Alternate flavours of the supplements to prevent taste fatigue.
What if I am still struggling to take my supplements?
Most will take the oral nutritional supplements by mouth, however, should you struggle to tolerate the quantity needed and if you experience weight loss as a result, they can also be given through a naso-gastric (NG) or naso-jejunal (NJ) tube. Speak with your dietitian and medical team about the options.
Things to note whilst on EEN:
- Your bowel habits may change when first starting EEN. Diarrhoea should start to improve over the course of the first 2-3 weeks, as the inflammation in your gut improves.
- Some may find that the diet makes their stools looser, particularly if your bowels were formed before starting EEN. This is a normal side effect of reducing the fibre content of your diet and should not be a cause for alarm.
- You may feel fatigued when initially starting EEN. This could be as a result of the change in your diet and should begin to improve once EEN is established. If it does not, speak with your dietitian or medical team, as it may be that your supplement intake needs adjusting.
- You may feel hungry in the initial stages of the diet. Consuming the non-nutritive items on page 3 may help. Speak with your dietitian if this does not improve as it may be that your supplement intake needs adjusting.
- Sometimes, taste changes can be associated with nutritional deficiencies in severe IBD, due to reduced absorption as a result of inflammation. This should improve gradually once EEN is established. If it does not, then speak with your medical team as you may require further investigation.
How do I transition back to normal eating and drinking?
As you near the end of your EEN trial, your dietitian will arrange to speak with you about dietary reintroduction.
There are a number of ways to reintroduce diet, and your dietitian will talk
you through the options.
You should follow EEN for the full 6-8 weeks to ensure you receive the optimum benefits of the treatment. However, should you feel unable to continue, speak with your dietitian or medical team, as it may be that early dietary reintroduction could be considered.
Other considerations
Early data suggests a partial enteral diet, whereby supplement drinks are taken alongside small amounts of food, may help to maintain disease remission and provide symptom relief. Discuss with your dietitian or healthcare team for further advice and support.
There is a small amount of evidence to support the use of EEN for up to 2
weeks in patients with Ulcerative Colitis. Discuss with your dietitian or healthcare team for further advice and support.
Contact details:
Telephone number/email address:
0300 615 3232 (Wexham Park Hospital)
0300 613 4053 (Frimley Park Hospital)
fhft.
Contact us
If you have any queries relating to this information, please contact the Dietetics service.
About this information
Service:
Dietetics
Reference:
DT/035
Approval date:
1 May 2025
Review date:
1 May 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.