Abstract：
Elemental diets have been employed for the management of various diseases for over 50 years, with several mechanisms mediating their beneficial effects. Yet, they are underutilized due to poor palatability, access, cost, and lack of awareness regarding their clinical efficacy. Therefore, in this review, we aimed to systematically search and review the literature to summarize the formulation variability, mechanisms of action, clinical applications, and tolerability of the elemental diets in gastrointestinal diseases. While large prospective trials are lacking, elemental diets appear to exhibit objective and subjective clinical benefit in several diseases, including eosinophilic esophagitis, eosinophilic gastroenteritis, inflammatory bowel diseases, small intestinal bacterial overgrowth, intestinal methanogen overgrowth, chemoradiotherapy-associated mucositis, and celiac disease. Although some data support the long-term use of elemental diets as an add-on supplement for chronic pancreatitis and Crohn\'s disease, most of the literature on exclusive elemental diets focuses on inducing remission. Therefore, subsequent treatment strategies for maintaining remission need to be adopted in chronic/relapsing diseases. Several mechanistic pathways were identified to mediate the effects of elemental diets, including food additive and allergen-free content, high passive absorption rate, and anti-inflammatory properties. High rates of intolerance up to 40% are seen in the trials where exclusive elemental diets were administered orally due to poor organoleptic acceptability; however, when tolerated, adverse events were rare. Other limitations of elemental diets are cost, access, and lifestyle/social restrictions. Moreover, judicious use is advised in presence of a concomitant restrictive food intake disorders. Elemental diets offer a potentially highly efficacious dietary intervention with minor side effects. Palatability, cost, access, and social restrictions are common barriers of use. Prospective clinical trials are needed to elucidate the role of elemental formulas in the management of individual diseases.
摘要：
元素饮食已被用于各种疾病的管理超过50年，有几种机制介导它们的有益作用。然而，由于适口性差，它们没有得到充分利用，access,成本,缺乏对其临床疗效的认识。因此,在这次审查中,我们旨在系统地搜索和回顾文献，以总结配方的变异性，行动机制,临床应用，和胃肠道疾病中元素饮食的耐受性。虽然缺乏大型前瞻性试验，元素饮食似乎在几种疾病中表现出客观和主观的临床益处，包括嗜酸性粒细胞性食管炎,嗜酸性粒细胞性胃肠炎,炎症性肠病，小肠细菌过度生长，肠道产甲烷菌过度生长，放化疗相关黏膜炎，还有乳糜泻.尽管一些数据支持长期使用元素饮食作为慢性胰腺炎和克罗恩病的附加补充剂，大多数关于独家元素饮食的文献都集中在诱导缓解上。因此,在慢性/复发性疾病中,需要采用维持缓解的后续治疗策略.确定了几种机制途径来介导元素饮食的影响，包括食品添加剂和无过敏原含量，高被动吸收率，和抗炎特性。在由于感官可接受性差而口服独家元素饮食的试验中，不耐受率高达40％；然而，当耐受时，不良事件罕见.元素饮食的其他限制是成本，access,和生活方式/社会限制。此外，建议在伴有限制性食物摄入障碍的情况下明智地使用。元素饮食提供潜在的高度有效的饮食干预，副作用较小。适口性,成本,access,社会限制是常见的使用障碍。需要前瞻性的临床试验来阐明基本公式在个体疾病管理中的作用。
