Exclusive enteral nutrition improves radiological outcomes in adults with perianal fistulizing Crohn's disease: A real‐world retrospective cohort study

Abstract Background Exclusive enteral nutrition (EEN) is effective in luminal Crohn's disease (CD). However, its role in perianal fistulizing Crohn's disease (PFCD) remains unclear. This study aimed to evaluate the radiological and clinical outcomes of EEN in adult patients with PFCD. Methods This retrospective real‐world cohort study included adult CD patients with draining perianal fistulas, as confirmed by magnetic resonance imaging (MRI). All patients received EEN for 8–12 weeks between January 2015 and December 2024. Pelvic MRI was performed before and after EEN. The primary endpoint was radiological healing. The secondary endpoints included radiological improvement, clinical fistula response and remission, overall clinical response and remission, endoscopic response and remission, C‐reactive protein (CRP) remission, and reductions in Van Assche Index (VAI) and modified VAI (m‐VAI) from baseline. Results Among 152 patients, radiological healing was observed in 12.5% of patients, with radiological improvement in 77.6% of cases. Clinical fistula response and remission were achieved in 55.9% and 47.4% of patients, respectively. After treatment, both VAI (12.0 [8.0, 15.0] vs 8.0 [6.0, 11.0], p < 0.001) and m‐VAI (9.0 [7.0, 12.8] vs 7.0 [4.3, 9.0], p < 0.001) significantly decreased. Overall clinical response and remission were observed in 73.0% and 24.3% of patients, respectively. Endoscopic response and remission occurred in 79.6% and 40.8% of patients, respectively. CRP remission was observed in of 77.6% patients. Concomitant antibiotics (odds ratio, 3.06; 95% confidence interval, 1.21–7.72; p = 0.018) were independently associated with radiological improvement. Conclusions EEN treatment was associated with improved radiological and clinical outcomes in patients with PFCD.