Risk/Benefit Strategies Must Be Employed in the Management of Pediatric Crohn’s Disease

Hyams, Jeffrey S.

doi:10.1159/000228563

Cited by 7 publications

(7 citation statements)

References 68 publications

(28 reference statements)

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“…The varying, but mostly poor, perceived palatability of oral feeds (particularly of elemental diets) seriously limits prolonged compliance and therefore impairs the delivery of the intended therapy, with withdrawal rates as high as 39% 35 . Tube feeding tends to achieve better compliance (withdrawal rates of 10%–26%) but does present its own occasional hazards 43 . Equally, EN therapy may be particularly valuable in optimizing symptom control in those with subcritical stenosis from small bowel strictures.…”

Section: Primary Therapeutic Nutrition For CDmentioning

confidence: 99%

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Nutrition in Inflammatory Bowel Disease

Forbes

Emma

Paulon

2011

J Parenter Enteral Nutr

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The diet of industrialized nations may contribute to the pathogenesis of both ulcerative colitis (UC) and Crohn disease (CD). Malnutrition is relatively unusual in UC, but in CD, which often affects the small intestine, it is frequent and may be severe. Nutrition support is therefore frequently indicated. First principles of artificial nutrition can be applied effectively using the gut whenever possible. Parenteral nutrition is generally required only in those with short bowel syndrome. An increasing literature (especially in pediatrics) favors the use of defined exclusive enteral nutrition (EN) in the primary treatment of active CD. Controlled trials are, however, lacking, and recommendations are accordingly not of the highest rank. It appears that in this context, simple polymeric regimens are usually sufficient, and there is currently insufficient evidence to make a strong recommendation for disease-specific feeds. In the maintenance of remission in CD, controlled data demonstrate that defined EN reduces the risk of relapse requiring steroid treatment. There are no data in support of primary nutrition therapy in UC either in management of the acute flare or in maintenance. In conclusion, nutrition therapy in adults with inflammatory bowel disease is probably both undervalued and underused, but the evidence base needs to be strengthened to confirm its efficacy, determine better those patients most likely to benefit, and optimize the regimens to be employed.

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Section: Primary Therapeutic Nutrition For CDmentioning

confidence: 99%

“…35 Tube feeding tends to achieve better compliance (withdrawal rates of 10%-26%) but does present its own occasional hazards. 43 Equally, EN therapy may be particularly valuable in optimizing symptom control in those with subcritical stenosis from small bowel strictures.…”

Section: Primary Nutrition Therapy Vs Steroids In Adults With CDmentioning

confidence: 99%

Nutrition in Inflammatory Bowel Disease

Forbes

Emma

Paulon

2011

J Parenter Enteral Nutr

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“…Nutritional follow-up by nutritionists, gastroenterologists, and clinicians during both the phase of remission and of inflammatory activity should be considered to be of fundamental importance for IBD patients in order reduce the risk of nutritional deficiencies and malnourishment. It has been repeatedly reported that enteral feeding with an elemental diet is just as effective as corticosteroids in inducing and maintaining remission, while maintaining a healthy nutritional status [25][26][27][28][29][30][31][32][33][34]. This therapy shows that nutritional therapy is efficacious and proves that diet is a major factor in managing IBD.…”

Section: Discussionmentioning

confidence: 92%

Relationship between Dietary Intake of Fatty Acids and Disease Activity in Pediatric Inflammatory Bowel Disease Patients

Ciresi

2012

Journal of the Academy of Nutrition and Dietetics

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Background. Crohn's disease (CD) and ulcerative colitis (UC), collectively known as inflammatory bowel disease (IBD), are chronic illnesses that affect predominately the gastrointestinal tract. The pathogenesis and etiology remain unclear but the importance of environmental factors, in particular diet, is evidenced by the increased incidence rates of the recent decades that genetic inheritance cannot account for. In particular, the quantity of fatty acid consumption has been consistently linked with IBD risk. While several studies have investigated the connections between diet, etiology, signs and symptoms associated with IBD, very few have explored the relationship between disease state and specific fatty acid intake in the pediatric IBD population. Methods. In this cross-sectional study, 100 pediatric patients from Cincinnati Children's Hospital and the Hospital for Sick Children in Toronto with diagnosed IBD (73 with Crohn's disease (CD) and 27 with ulcerative colitis (UC)) were included. Three-day diet records were collected from the patients for the assessment of their dietary intake. The abbreviated Pediatric Crohn's Disease Activity Index (PCDAI), the abbreviated Ulcerative Colitis Activity Index (PUCAI), and markers of inflammation (lipopolysaccharide binding protein (LBP) and S100A12) were used to assess disease severity. A logistic regression analysis was carried out to correlate disease severity with the dietary intake of specific fatty acids and total dietary intake. Results. Total caloric, saturated fat (SFA), and monounsaturated fat (MUFA) intake were negatively associated (p<0.05) with PCDAI scores in CD alone. The individual SFAs butyric, caproic, caprylic, capric, lauric, myristic, palmitic, margaric, and stearic also were also negatively associated with disease activity scores in CD group. However, no significant associations were iii observed between the major types of fatty acids and markers of inflammation. Margaric acid was the only fatty acid significantly associated (p<0.05) with the markers of inflammation, as it was positively correlated with S100A12. Discussion. Our analysis indicates that both total fatty acid intake and total caloric intake were inversely associated with disease activity. A change in habitual dietary intake is the most likely explanation for this negatively associated trend. Relapsed patients consumed significantly lesser amounts of fatty acids and calories than patients who were in remission. The importance of this relationship should not be disregarded since pediatric IBD patients are at a high risk for growth failure, delayed puberty, anemia, osteoporosis, and other medical conditions. This study adds reason for the importance of follow-ups with nutrition professionals and gastroenterologists during remission and active states in order for pediatric IBD patients to maintain a healthy nutritional status.

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“…A risk-benefit strategy is advised in the management of pediatric CD, with anti-TNF as monotherapy for patients at high risk for rapid disease progression. 26,27 The potential of anti-TNF to alter the natural history in pediatric CD is however still unclear. 26,28 The use of IM eventually combined with anti-TNF has been limited because of the rare but fatal occurrence of hepatosplenic T-cell lymphoma.…”

mentioning

confidence: 99%

“…26,27 The potential of anti-TNF to alter the natural history in pediatric CD is however still unclear. 26,28 The use of IM eventually combined with anti-TNF has been limited because of the rare but fatal occurrence of hepatosplenic T-cell lymphoma. 26 Risk stratification with existing tools demonstrated a reduction of complications with anti-TNF and IM treatment in patients at high risk, but no reduction in low-risk patients.…”

mentioning

confidence: 99%