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Effect of total parenteral nutrition on serum concentrations of eight proteins in Crohn's disease.

In 15 patients with Crohn's disease a study was made of the effect of total parenteral nutrition (TPN) (nil per os) on the serum concentrations of albumin, transferrin, orosomucoid, haptoglobin, alpha 1-antitrypsin, IgG, IgA, and IgM, and on the hemoglobin concentration in blood and the erythrocyte sedimentation rate. The study covered 22 periods of TPN, each of at least 21 days. At introduction of TPN one group of steroid-free patients (group I) displayed clinical and laboratory signs of severe malnutrition and a high level of activity of the disease. Another group of patients without steroid medication showed signs of incipient or mild malnutrition and mild to moderate activity (group II). The patients receiving prednisolone were assigned to a separate group (group III). During the first 3 wk of TPN the S-albumin and S-transferrin levels increased in group I, whereas the S-orosomucoid and S-alpha 1-antitrypsin concentrations decreased parallel with a clinical improvement. In groups II and III, however, there was no convincing biochemical sign of improvement during the initial 3-6 wk of TPN. In both groups I and II there was an increase in, particularly, the S-IgM level of the immunoglobulins. It is concluded that steroid-free patients with Crohn's disease displaying signs of severe malnutrition and highly active disease are likely to show biochemical and clinical evidence of improvement after 3 wk of TPN; the response to TPN is related to the initial status of the patient.