CASE REPORT article
Front. Nutr.
Sec. Clinical Nutrition
This article is part of the Research TopicPerioperative Optimization and Perioperative Medicine: Optimizing Outcomes and Safety across Surgical CareView all 13 articles
Targeted Nutritional Prehabilitation for High-Risk Crohn's Disease Patients Undergoing Elective Gastrointestinal Surgery: a case series
Provisionally accepted
- 1Unit of Gastroenterology and Endoscopy, University Hospital of Parma, Parma, Italy
- 2Department of Medicine and Surgery, University of Parma, Parma, Italy
- 3Department of Translational Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
- 4Department of General Surgery, Fondazione Poliambulanza, Brescia, Italy
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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), was shown to help restore the intestinal barrier, promote a balanced immune response, and mitigate the inflammatory process. Thus, it may be implemented in 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 3 out of 4 cases. Nutritional status was maintained in all cases. CRP and albumin were within normal values. Two patients stopped 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 advocated.
Keywords: Crohn's disease, Crohn's disease exclusion diet, Partial enteralnutrition, postoperative outcomes, Preoperative nutrition
Received: 24 Oct 2025; Accepted: 09 Feb 2026.
Copyright: © 2026 Vincenzi, Gaiani, Carra and de'Angelis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francesca Vincenzi
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