How effective is enteral nutrition in inducing clinical remission in active Crohn's disease? A meta-analysis of the randomised controlled trials

Fernández-Bañares, F.; Cabré, E.; Esteve, M.; Gassull, M.A.

doi:10.1016/0261-5614(94)90158-9

Cited by 5 publications

(9 citation statements)

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“…The adult studies have been well reviewed elsewhere. [29][30][31] Sanderson et al [32] compared a peptide-based, semi-elemental diet with corticosteroid therapy in children with small bowel disease and found equal efficacy with both groups in the induction of remission, but a better effect on long term linear growth in the group treated with enteral nutrition. The diet was given for 6 weeks as sole therapy.…”

Section: Enteral Nutritionmentioning

confidence: 99%

“…There have been numerous trials in adults which suggest that polymeric diets are probably as effective as elemental diets. [29][30][31] …”

Section: Enteral Nutritionmentioning

confidence: 99%

“…These have been put together in a meta-analysis by Fernandez-Banares et al [30] and Griffiths et al [29] Both meta-analyses concluded that corticosteroids were more efficacious than diet in the induction of remission and that, whether or not elemental or polymeric diets were used, results were similar. Many of the studies quoted were flawed by poor compliance and the results need to be balanced against the potential toxicity of corticosteroid therapy.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…These meta-analyses have led to a change in adult practice with the widespread acceptance of corticosteroids as primary therapy in patients with Crohn's disease. [29,30] However, the conclusions of the above metaanalyses cannot automatically be extrapolated to children. In children, compliance with enteral nutrition is better, enteral nutrition is given for longer, there are more patients with new rather than long standing disease, and there is the additional dimension of growth and development with the need to avoid corticosteroids where possible because of the adverse effects on growth.…”

Section: Corticosteroidsmentioning

confidence: 99%

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Therapy of Crohn??s Disease in Childhood

Beattie

2000

Paediatric Drugs

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Crohn's disease in childhood is a chronic relapsing condition with a high morbidity. Growth failure is common. The aim of therapy is to induce and then maintain disease remission and thereby promote well-being and normal growth and development. Enteral nutrition (either polymeric or elemental) is effective and used as initial therapy. This is employed as sole therapy over a 6- to 8-week period followed by a period of controlled food reintroduction. The relapse rate is high and further courses of enteral nutrition or alternative therapies are frequently required. Corticosteroids are also effective as initial therapy and are required in difficult cases but there are problems with their long term use, particularly their adverse effects on growth. Many patients develop either corticosteroid-dependent or corticosteroid-resistant disease. In this instance, additional immunosuppression, such as azathioprine, can be used. Surgery is required for those patients with disease resistant to medical therapy and this will result in remission; however, the relapse rate with surgery is high. There are many areas for future research. Very little is known about why enteral nutrition works, how long it should be given or its role as maintenance therapy. Newer immunosuppressive strategies based on cytokine modulation may be helpful in children once more experience is gained from their use in adults.

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Section: Enteral Nutritionmentioning

confidence: 99%

“…There have been numerous trials in adults which suggest that polymeric diets are probably as effective as elemental diets. [29][30][31] …”

Section: Enteral Nutritionmentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%

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Therapy of Crohn??s Disease in Childhood

Beattie

2000

Paediatric Drugs

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“…This can either be elemental (aminoacid-based), protein hydrolysate (peptidecontaining) or polymeric (containing whole protein and not therefore hypoallergenic ), and is given for 4-6 weeks as the sole nutritional source [39,40] . This approach is probably as effective as corticosteroid therapy in the short-term, about 60% patients achieving remission.…”

Section: Dietary Therapy (Table 1)mentioning

confidence: 99%