Japanese physicians' attitudes towards enteral nutrition treatment for pediatric patients with Crohn's disease: a questionnaire survey

Abstract

Background/AimsEnteral nutrition (EN) is recommended for the treatment of pediatric Crohn's disease (CD) in Japan. However, the indications and treatment protocols for EN vary among hospitals. In the present study, we aimed to determine how EN was administered to pediatric patients and whether physicians followed treatment guidelines in their practices.MethodsTwo types of questionnaires were administered to 32 physicians who were involved in the treatment of pediatric CD. The consensus questionnaire evaluated the physicians' attitudes towards EN, whereas the efficacy questionnaire collected data on patients with CD, aged <17 years, who had undergone induction therapy between 2006 and 2011.ResultsA total of 23 physicians responded to the questionnaires. The results of the consensus questionnaire indicated that 82% and 59% of study participants recommended EN treatment for all newly diagnosed pediatric patients with CD and all relapsed patients, respectively. Exclusive EN (EEN) and elemental formula were recommended by 84% and 85% of physicians, respectively. The efficacy questionnaire revealed that 57 of the 58 patients received EN. Elemental formula was used in 39 of 40 patients who were treated with EEN. Of these 40 patients, 27 were treated with EEN alone; of these, 22 (81%) achieved remission without any other treatment. The mean duration of EEN was 15.9 days.ConclusionsEN is widely recommended by physicians treating pediatric CD in Japan. In contrast to Western countries, clinicians used elemental formula more often and with a shorter EEN treatment duration.

Exclusive enteral nutrition in children with inflammatory bowel disease: Physician perspectives and practice

“…The current study found that all respondents would definitely or probably use EEN to induce remission in newly diagnosed CD compared to a previous survey, which found that only 60% of respondents felt EEN to be appropriate for CD . The reported rates of usage of EEN for active CD are greater than that reported by European and Japanese physicians . In the current study, EEN was more commonly used for CD with moderate to severe disease activity than for children with mild disease activity.…”

“…However, other international practices differ widely; previous surveys indicated that 52% of Swedish clinicians recommend 6 weeks’ duration, whilst 30% of North American clinicians recommend less than 6 weeks and 46% recommend 6–8 weeks’ duration . In contrast, in a different assessment, Japanese gastroenterologists only prescribed EEN for a mean duration of 15.9 days in children with active CD …”

“…A recent global survey (that included Canada, USA, UK, Spain, and other European countries) found that 88% of respondents use polymeric formula . In contrast, Japanese clinicians almost universally prefer elemental formulae . The most recent Cochrane study and a separate randomized control trial found no significant difference between elemental and polymeric formulae in terms of inducing remission for CD .…”

“…A previous report showed that EEN is more commonly used by European than North American gastroenterologists . Other surveys have found that EEN practices and protocols vary between countries …”

Elemental Diet Enriched with Amino Acids Alleviates Mucosal Inflammatory Response and Prevents Colonic Epithelial Barrier Dysfunction in Mice with DSS-Induced Chronic Colitis

“…Although a previous study by Souza et al revealed that the consumption of amino acid diets can exacerbate experimental colitis [24], clinical outcomes suggest the opposite. Exclusive enteral nutrition with ED amino acids has been used extensively for the application of IBD therapy, and this has been proven effective in achieving and maintaining remission [25,26]. During an inflammatory flare, IBD patients are at a high risk of nutrient depletion, and this is particularly true for children [27].…”