The efficacy of exclusive nutritional therapy in paediatric Crohn’s disease, comparing fractionated oral vs. continuous enteral feeding

Abstract

SUMMARY Background

Nutritional management of Crohn’s disease

“…Indeed, EN should be considered in appropriate patients. The challenge, however, is to know who these are: there are no trials comparing EN versus placebo; it is unclear how long exclusive EN is needed; and data are very heterogeneous with regards to response related to disease distribution [Wilschanski et al 1996;Afzal, 2009, Buchanan et al 2009, Rubio et al 2011.…”

“…Supported by evidence of efficacy from the paediatric literature [Rubio et al 2011], there has only been one fully published trial in adult patients with CD [Triantafillidis et al 2006]. In an uncontrolled observational study of patients with active CD given 4 weeks of exclusive Modulen IBD (Nestlé, Lausanne, Switzerland), 11 out of 29 patients were in remission [as defined by Crohn's Disease Activity Index (CDAI) < 150] and a further 8 had a response (CDAI drop > 50) [Triantafillidis et al 2006].…”

Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with Crohn's disease

“…Of note, all the studies that have demonstrated mucosal healing from EEN have been after 8 weeks or more of EEN. 34,35 In addition, faecal inflammatory markers have been demonstrated to continue to fall upto 8 weeks of EEN suggesting until further evidence evolves that 8 weeks is the optimal course length based on data from current studies. 36 There is a paucity of published data describing clinical outcomes from second courses of EEN in children and whether the benefits already discussed in terms of improvements in anthropometric and inflammatory markers are reproducible in subsequent EEN courses.…”

Exclusive enteral nutrition and induction of remission of active Crohn’s disease in children

“…One report has compared outcomes of EEN administration with those of formula delivered via an NG tube [23]. Eighty-five percent of the children who received EEN via NG tube were in remission after 8 weeks contrasting to 75% of the oral group.…”

“…Rubio et al described their retrospective experience with EEN in 106 children with newly diagnosed CD. Remission was assessed after 8 weeks of EEN and was classified as a Pediatric Crohn's Disease Activity Index of <10 [23]. Overall, 81.1% of this group entered remission with EEN.…”