Ulcerative colitis / Crohn's disease: no clear role for bowel rest.

Clinical bottom line (level 1b-)

  1. Patients with acute severe colitis who had parenteral nutrition were not clearly more likely to improve or avoid surgery than those who had an ordinary diet.
McIntyre et al: Gut 1986; 27: 481-485
Expires May 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: two acute hospitals, UK and France

47 patients (aged range 17 to 72 years; mean 36, 60% female) with severe acute non-infective colitis (27 with ulcerative colitis, 16 with Crohn's disease)
Control Group: (n = 20, 20 analysed): oral diet: hospital meals supplemented as necessary to maintain nitrogen and calorie intake
Experimental Group: (n = 27, 27 analysed): 'bowel rest': parenteral nutrition and water only by mouth
All patients had 20 mg iv prednisolone twice daily, and had only clear fluids by mouth for 36 hours.
100% followed for 7 days
Outcome notes:
  • surgery : based on joint decision of physicians and surgeons

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
no change or worse symptoms 7 days 8
(40.0%)		 11
(40.7%)		 -2%
(-106% to 50%)		 -0.74%
(-29.1% to 27.6%)		 -140
(NNT = 4 to infinity;
NNH = 3 to infinity)
surgery 7 days 1
(5.00%)		 3
(11.1%)		 -122%
(-1882% to 75%)		 -6.11%
(-21.3% to 9.11%)		 -16
(NNT = 11 to infinity;
NNH = 5 to infinity)

Comments

  1. The study is too small to show any small benefit or harm from bowel rest.

Citation

  1. McIntyre P, Powell-Tuck J, Wood SR, et al: A controlled trial of bowel rest in the treatment of severe acute colitis. Gut 1986; 27: 481-485
Search Terms: Crohn* in Cochrane
Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer:

Clinical Question.
Patient acute severe colitis
Intervention or Exposure parenteral nutrition
Comparison ordinary diet
Outcome improvement, surgery