Enteral Nutrition Should Be Used to Induce Remission in Childhood Crohn’s Disease

Abstract

Background: Exclusive enteral nutrition has been used over many years as a therapy to try and achieve a remission in adults and children presenting with acute Crohn’s disease. Despite its reported efficacy at achieving clinical responses in excess of 80% in some case series, it has not been taken up widely as a first-line therapy. This is, at least in part, due to the lack of a large prospective randomised study. Methods: The literature is replete with small case series and anecdotal reports from units who use this therapy. Recent literature is reviewed on efficacy, application, composition and potential mechanisms of action of this therapy. Results: Although the evidence base remains quite limited, further data are available that suggest a clear benefit of exclusive enteral nutrition as an efficacious alternative to steroid therapy at inducing a clinical remission in Crohn’s disease. Certain sub-groups are likely to benefit more, with potential benefits on growth making it particularly useful in adolescents and growing young adults. Given the lack of side effects compared to the alternative of steroid therapy, along with the clear nutritional benefits of this therapy, it remains an obvious choice for patients presenting with Crohn’s disease and a degree of malnutrition. Conclusions: This therapy should remain a first-line therapy for children and adults presenting with mild to moderate Crohn’s disease.

Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn’s disease

“…[3][4][5][6] Exclusive enteral nutrition (EEN) has been proposed to be a firstline therapy for induction of clinical remission in active pediatric CD. 7,8 The precise mechanisms underlying the action of EEN are poorly understood. It is currently suggested to involve antiinflammatory effects, inducing mucosal healing, modifying intestinal microbiota and helping bowel rest.…”

Influence of Exclusive Enteral Nutrition Therapy on Bone Density and Geometry in Newly Diagnosed Pediatric Crohn's Disease Patients

“…In children with Crohn's disease (CD), exclusive enteral nutrition (EEN) therapy is as effective as systemic corticosteroids in inducing remission [1,2] and even superior in terms of mucosal healing, side effects, correction of malnutrition, and patients' general well-being [3,4,5,6]. Furthermore, EEN may have additional benefits on bone health.…”

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

“…The evidence on the efficacy of EN in maintaining remission is controversial, and there are many unknowns including what proportion of calories should come from formula and use of concomitant medications. Given the controversial nature of this evidence and the fact that adhering to this therapy past the induction phase is very challenging, a medication to maintain remission should be chosen early in the course of EN . Thiopurines are reported to be used most commonly in maintenance of remission and are typically implemented shortly after the initiation of EN …”