Targeted nutritional prehabilitation for high-risk Crohn’s disease patients undergoing elective gastrointestinal surgery: a case series

Background: Crohn's disease (CD) is a chronic inflammatory bowel condition often leading to complications requiring surgery. Optimizing nutrition before surgery contributes to reducing postoperative complications. The Crohn's Disease Exclusion Diet (CDED), combined with Modulen as partial enteral nutrition (PEN), has been shown to help restore the intestinal barrier, promote a balanced immune response, and mitigate the inflammatory process (Modulen: Nestlé Italia S.p.A: Milan, Italy). Thus, this approach may be implemented into a prehabilitation protocol to tailor nutritional interventions for candidates undergoing CD surgery. Methods: We describe four adult CD patients who underwent preoperative nutritional optimization with CDED+PEN. Interventions lasted 2-12 weeks, providing 30-35 kcal/kg/day, and were tailored based on weight and appetite. Adherence, nutritional markers, medical therapy, and surgical outcomes were monitored. Results: All patients showed good adherence and tolerance to CDED+PEN, with no flare-ups or treatment discontinuations. CDAI decreased in three of four cases. Nutritional status was maintained in all cases. CRP and albumin remained within normal values. Two patients discontinued biologics before surgery without complications, while two were managed without pharmacological therapy. All patients underwent robotic intestinal resection with no postoperative complications. Conclusion: CDED+PEN may be incorporated into the prehabilitation protocol to enhance the nutritional and inflammatory status of CD patients undergoing surgery. Clinical trials assessing its efficacy and tolerance are warranted.