Abstract Background Exclusive enteral nutrition (EEN) is an established induction therapy in pediatric Crohn’s disease (CD), but its role in adults remains less well defined. We conducted a systematic review and meta-analysis of randomized trials and cohort studies to evaluate the efficacy and safety of EEN for induction of remission in adults with active CD. Methods A systematic search was performed through June 2025. Eligible studies included randomized controlled trials(RCTs) and non-randomized studies evaluating EEN in adults(≥18 years) with active CD. The primary outcome was clinical remission, defined by validated disease activity indices. Risk of bias was assessed using RoB 2 and the Newcastle-Ottawa Scale. Random-effects models were applied to estimate pooled remission rates and relative risks. Results Thirty-five studies comprising 1642 patients were included. In 20 real world cohort studies(n = 936), the pooled clinical remission rate with EEN was 60%(95%CI:49–70, I²=74%). In five RCTs(n = 315) comparing corticosteroids with EEN, corticosteroids achieved higher remission rates compared with EEN(76%vs.46%; RR 0.65, 95%CI:0.50–0.84; p=0.0009). In eight RCTs(n = 301), remission rates did not differ significantly between elemental and non-elemental formulations (65%vs.60%; RR 1.04, 95%CI:0.88–1.23). Subgroup analyses by protein type and lipid composition showed no differences in efficacy. Adverse events were generally mild, with poor palatability being most frequent. Conclusion EEN induces clinical remission in adults with CD in real world studies. It is less efficacious than corticosteroids to induce clinical remission. The efficacy of EEN is independent of formula composition. Given its favourable safety profile, EEN may represent a therapeutic option in select adult patients. Conflict of interest: Kaur, Kirandeep: No conflict of interest Dr. Singh, Arshdeep: No conflict of interest Kaur, Simrat: No conflict of interest Sharma, Riya: No conflict of interest Bhardwaj, Arshia: No conflict of interest Jena, Anuraag: None Midha, Vandana: No conflict of interest Sood, Ajit: Ajit Sood received honorarium for speaker events from Pfizer India and Takeda India.
Kaur et al. (Thu,) studied this question.