Short-Term Efficacy of Exclusive Enteral Nutrition in Pediatric Crohn’s Disease: Practice in China

Abstract

Aims. The objective of this study was to compare the efficacy of exclusive enteral nutrition (EEN) and corticosteroids in inducing remission in pediatric Crohn's disease (CD) and the effects of the treatment on growth improvements. Methods. Data was retrospectively collected for children and adolescents newly diagnosed with CD in a referral center. Patients who were followed up for more than 2 months with mild to moderate disease were included. Basic demographics, history, physical examination, the pediatric Crohn disease activity index (PCDAI), laboratory findings, endoscopic findings, and adverse effects were recorded. Remission was defined as PCDAI < 10 points. Results. Ten subjects received EEN and 18 patients received corticosteroids. The median follow-up in EEN group and steroid group was 9.2 weeks and 9.6 weeks, respectively. The remission rate in EEN group was significantly higher than that in steroid group (90.0% versus 50.0%, resp., P < 0.05). Growth improvement, which was evaluated by changes in height for age z-score, was more apparent in EEN group than that in steroids group (P < 0.05). No adverse effects were observed in EEN group. Conclusions. In children with mild to moderate CD, EEN is more effective than corticosteroids in improving disease severity and growth deficiency, as well as providing less side effects.

Systematic review with meta‐analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease

“…Of the eight trials included in the quantitative meta‐analysis, seven compared EEN to CS (Borreli et al., Berni Canani et al., Hojsak et al., Kierkus et al., Lambert et al . Levine et al., Luo et al …”

“…The study participants in all trials included in the meta‐analysis were children, and the diets were administered via nasogastric tube (elemental diets) or orally. Of the eight studies, four studies (Lambert, Levine, Borrelli, Luo) included only newly diagnosed patients, whereas the others included both newly diagnosed and relapsed patients, or relapsed only. Disease activity and remission were based on PCDAI scores, though the cutoff for remission varied and some studies did include supplemental information from biomarkers or endoscopic scores (CDEIS).…”

“…Sanderson et al . was the only study which used an elemental diet only arm and Lou et al . did not specify the type of formula used in their study.…”

“…Sanderson et al 29 used an elemental diet, and Berni Canani et al 35 had separate arms for elemental, semi elemental and polymeric diets that were pooled together for our meta-analysis. Luo et al 36 did not specify the type of enteral nutrition that they used.…”

“…Of the eight studies, four studies (Lambert, 24 Levine, 25 Borrelli, 26 Given the interest in possible treatment differences between newly diagnosed CD patients and those with relapsed disease, the studies were separately analysed by type of patient. Borrelli et al, 26 Lambert et al, 24 Levine et al 25 and Lou et al 36 included only newly diagnosed patients. Although these studies were an RCT, two retrospective cohort studies and a prospective cohort study, respectively, we combined them to do an exploratory analysis.…”