In patients suffering from acute severe ulcerative colitis, the exclusive enteral nutrition for seven days may augment corticosteroid responsiveness. 

An open-label randomized controlled trial was performed to examine the efficacy of exclusive enteral nutrition  as adjunctive treatment to intravenous corticosteroids in individuals with acute severe ulcerative colitis.

In total, 62 participants (mean age 35.3 ± 12.1 years) were randomized either to an exclusive enteral nutrition group (subjects received a semi-elemental formula for seven days along with the standard of care, n=32) or standard of care group (n=30). Corticosteroid failure, defined by the requirement for salvage medical treatment or colectomy was the major endpoint. Utilizing 16s ribosomal RNA sequencing, the fecal microbial analysis was carried out on day 1 and day 7 in some individuals.

In comparison with the standard of care group, the corticosteroid failure was found to be reduced in the exclusive enteral nutrition group, without any vital difference in colectomy rate. Subjects treated with exclusive enteral nutrition were found to have a shorter hospital stay, elevated albumin level at 7th day, a greater decline in serum C-reactive protein and fecal calprotectin levels, and a decreased composite outcome of colectomy/hospitalization at six months in comparison with the standard of care group, as shown below:

In comparison with the standard of care group, the individuals receiving exclusive enteral nutrition displayed an elevated abundance of Erysipelotrichaceae on the 7th day, with decreased Bifidobacterium and Veillonellaceae.

The exclusive enteral nutrition for seven days may augment corticosteroid responsiveness and is therefore advantageous to manage acute severe ulcerative colitis patients.