NORMALISATION OF MUCOSAL CYTOKINE mRNA IN ASSOCIATION WITH CLINICAL IMPROVEMENT IN CHILDREN WITH CROHN'S DISEASE TREATED WITH POLYMERIC DIET.

Fell, John; Hollis, Austin W.; Paintin, M; Arnaud-Battandier, F; MacDonald, Thomas T.; Walker-Smith, J A

doi:10.1097/00005176-199805000-00043

Cited by 9 publications

(8 citation statements)

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“…Endoscopic examination revealed that the appearance and histology of the mucosal tissue were also significantly improved 38 . In addition, there was a reduction in the mRNA levels for the pro‐inflammatory cytokines IL‐1β, IL‐8 and IFN‐γ, with an accompanying increase in endogenous TGF‐β 39 . This is a further indication of the return of the injured host to homeostasis.…”

Section: Clinical Evidencementioning

confidence: 96%

“…To date, two cohort studies have been performed. The first study was a small study of patients with primarily small bowel disease, 38 while the second followed patients with different forms of the disease 39 . In both studies, patients received the TGF‐β2 diet for 8 weeks as their sole nutrition, followed by a 4‐week period of controlled reintroduction to normal food.…”

Section: Clinical Evidencementioning

confidence: 99%

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Bioactive molecules in milk and their role in health and disease: The role of transforming growth factor‐β

et al. 2000

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Summary Human breast milk is rich in nutrients, hormones, growth factors and immunoactive molecules, which influence the growth, development and immune status of the newborn infant. Although several of these factors are also present in bovine milk, the greater susceptibility of the formula-fed infant to infection and disease and the development of allergy is often attributed to the reduced level of protective factors in milk formulas. Nevertheless, modifying manufacturing processes may preserve the biological activity of some bioactive molecules in end products. Transforming growth factor (TGF)-β is one such molecule. TGF-β is a polypeptide, which has been described in both human and bovine milk. It is implicated in many processes, including epithelial cell growth and differentiation, development, carcinogenesis and immune regulation. The present article discusses the biological activity of TGF-β2 that has been preserved and activated in a cow's milk-based product. More specifically, it addresses possible mechanisms of action in the intestinal lumen and speculates on how milk products containing naturally occurring TGF-β2 could be exploited in functional foods for the infant or as therapies for specific intestinal diseases.

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Section: Clinical Evidencementioning

confidence: 96%

Section: Clinical Evidencementioning

confidence: 99%

Bioactive molecules in milk and their role in health and disease: The role of transforming growth factor‐β

et al. 2000

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“…The mucosal cytokine responses of a much larger cohort of children were reported by Fell et al [79] . Whilst clear clinical and histological remission was achieved in over 70% of children, cytokine profiles also dramatically improved with a polymeric diet alone.…”

Section: Mucosal Healingmentioning

confidence: 74%

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

Heuschkel

2009

Dig Dis

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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.

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“…Recent observational studies with more palatable polymeric diets are confirming excellent compliance in children who take the diet by mouth (49,50). Successful use of enteral nutrition also requires motivated nursing, dietetic, and medical staff to support children and families during therapy.…”

Section: Discussionmentioning

confidence: 99%

Enteral Nutrition and Corticosteroids in the Treatment of Acute Crohn's Disease in Children

Heuschkel,

Menache,

Megerian

et al. 2000

J. pediatr. gastroenterol. nutr.

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Background:The optimal treatment of acute Crohn's disease in children remains controversial. In adults, steroid therapy has been shown to be superior to exclusive enteral nutrition. However, enteral nutrition is effective at inducing a remission in many children with acute Crohn's disease. Steroid usage in children has been associated with adverse side effects, particularly with delayed growth and pubertal development.Methods:Randomized clinical trials comparing exclusive enteral nutrition with corticosteroids were identified. Two independent reviewers extracted data from selected studies. Studies were assessed for heterogeneity and relative risks for remission induction with enteral nutrition were obtained. Sensitivity analyses were performed in partially randomized studies. Estimates were made of the number of studies needed to overturn the current result. Other outcome measures were qualitatively assessed.Results:In five randomized clinical trials comprising 147 patients, enteral nutrition was as effective as corticosteroids at inducing a remission (RR = 0.95 [95% confidence interval 0.67, 1.34]). Addition of two further nonrandomized trials did not significantly alter the result. A minimum of 10 further studies, equal in size and outcome to the largest reported pediatric trial to date (n = 68, RR = 0.84), would be required to demonstrate a significant benefit of steroid therapy over enteral nutrition.Conclusions:There is no difference in efficacy between enteral nutrition and corticosteroid therapy in the treatment of acute Crohn's disease in children. Improved growth and development, without the side effects of steroid therapy, make enteral nutrition a better choice for first‐line therapy in children with active Crohn's disease.

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NORMALISATION OF MUCOSAL CYTOKINE mRNA IN ASSOCIATION WITH CLINICAL IMPROVEMENT IN CHILDREN WITH CROHN'S DISEASE TREATED WITH POLYMERIC DIET.

Cited by 9 publications

References 0 publications

Bioactive molecules in milk and their role in health and disease: The role of transforming growth factor‐β

Bioactive molecules in milk and their role in health and disease: The role of transforming growth factor‐β

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

Enteral Nutrition and Corticosteroids in the Treatment of Acute Crohn's Disease in Children

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