The efficacy of total enteral nutrition in inducing remission and improving nutritional status in children with moderate to severe Crohn’s disease

Kierkuś, Jarosław; Szymańska, Sylwia; Szczepański, Michał; Wiernicka, Anna; Szymańska, Edyta; Matuszczyk, Małgorzata; Ryżko, Józef

doi:10.5114/pg.2013.34184

Cited by 3 publications

(12 citation statements)

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“…After these full texts were studied, the bibliographies were checked. Overall, 4 RCTs [38–41] and 14 observational studies [42–55] that reached our inclusion criteria constituted the base of our analysis. Three of the observational studies were abstracts that provided necessary data for inclusion in the meta-analysis (Fig.…”

Section: Resultsmentioning

confidence: 99%

Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis

Chen

2019

World J Pediatr

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Background Many studies have examined the effects of exclusive enteral nutrition (EEN) in children with Crohn’s disease (CD), but corticosteroids are considered a superior therapy and are frequently used in China. This meta-analysis aims to compare the efficacy of EEN with corticosteroids in treating pediatric CD. Methods A comprehensive retrieval from medical databases, including PubMed, EMBASE, MEDLINE, Web of Science, Wanfang data, VIP and CNKI, was performed using the search terms “diet therapy”, “exclusive enteral nutrition”, “Crohn’s disease”, “inflammatory bowel diseases”, “child” and “pediatrics” from January 1990 to April 2017. Results We included 18 studies from 1329 identified sources in this meta-analysis. EEN was as effective as corticosteroids in inducing remission rate of children suffering from CD (OR = 1.35; 95% CI 0.90, 2.10; P = 0.14). Nevertheless, patients who received EEN were more likely to achieve both endoscopic mucosal healing (OR = 5.24; 95% CI 2.06, 13.37; P = 0.0005) and histological mucosal healing (OR = 4.78; 95% CI 1.89, 12.08; P = 0.0009) than those who received corticosteroids; the Pediatric Crohn’s Disease Activity Index was lower [mean difference (MD) = − 3.67; 95% CI − 4.91, − 2.43] and weight gain was higher (MD = 1.92; 95% CI 0.02, 3.83; P = 0.05) in those patients who received EEN than in those who received corticosteroids. No difference was found in relapse rate (OR = 0.57; 95% CI 0.25, 1.29; P = 0.18), height for age or body mass index between the patients treated with EEN and corticosteroids at the 1-year end point. Conclusions This meta-analysis reveals that there is no significant difference between EEN and corticosteroids in the efficacy of inducing remission rate of CD in a pediatric population, but EEN is superior to corticosteroids in improving short-term mucosal inflammation and reducing the PCDAI index. Electronic supplementary material The online version of this article (10.1007/s12519-018-0204-0) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis

Chen

2019

World J Pediatr

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“…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 …”

Section: Resultsmentioning

confidence: 99%

“…No statistically significant difference was demonstrated (OR 1.61 [95% CI .87−2.98]; Figure A). A subanalysis of the three studies including only relapsed patients (Hojsak et al., Kierkus et al., Sanderson et al B).…”

Section: Resultsmentioning

confidence: 99%

“…The majority of the included studies (Hojsak et al., Kierkas et al., Lambert et al., Levine et al., and Borrelli et al …”

Section: Resultsmentioning

confidence: 99%

“…In the 10 years that have elapsed since the most recent meta‐analysis on this subject, several more studies, have been published, which have included new data on biomarkers and mucosal healing, two previously unexplored end points. Therefore, we performed an updated systematic review and meta‐analysis on the efficacy of CS vs EEN in the paediatric population.…”

Section: Introductionmentioning

confidence: 99%

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

Swaminath

Feathers

Ananthakrishnan

et al. 2017

Aliment Pharmacol Ther

128

106

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Background Despite potential adverse-events in a pediatric population, corticosteroids (CS) are used to induce remission in pediatric Crohn’s disease. Exclusive enteral nutrition (EEN) also induces remission, but is infrequently used in the United States because CS is considered the superior therapy. New data have become available since the publication of the most recent meta-analysis in 2007. Methods All studies with comparator arms of EEN and an exclusive CS, with remission clearly defined were identified. Online bibliographic databases including MEDLINE, EMBASE, Web of Science, Cochrane Databases, Open Grey, Grey Lit, Clinicaltrials.gov, and the WHO lists of clinical trials were searched. Results Of 2795 identified sources, nine studies met our inclusion criteria. Eight of these (n=451), had data that could be abstracted into our meta-analysis. EEN was as effective as CS in inducing remission (OR=1.26 [95% CI 0.77, 2.05] in pediatric Crohn’s disease. There was no difference between EEN and CS efficacy when comparing newly diagnosed Crohn’s (OR = 1.61 [ 95% CI 0.87, 2.98]) or relapsed (OR = 0.76 [95% CI 0.29–1.98]). Intestinal healing was significantly more likely among patients receiving EEN compared to CS (OR=4.5 [95% CI 1.64, 12.32]). There was no difference in the frequency of biomarker normalization including CRP (OR=.85 [.44, 1.67]) and fecal calprotectin (OR 2.79 [95% CI 0.79–10.90]). Conclusion There is no difference in efficacy between EEN and CS in induction of remission in Crohn’s disease in a pediatric population. Exploratory analyses suggest that a greater proportion of patients treated with EEN achieved mucosal healing.

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Microbiota signatures and mucosal healing in the use of enteral nutrition therapy v. corticosteroids for the treatment of children with Crohn’s disease: a systematic review and meta-analysis

et al. 2023

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Corticosteroids (CS) and exclusive and partial enteral nutrition (EEN & PEN) are effective therapies in paediatric Crohn’s disease (CD). This systematic review of randomised controlled trials (RCTs) and cohort studies analyses the impact of EEN/PEN versus CS on intestinal microbiota, mucosal healing as well as other clinically important outcomes, including clinical remission, relapse, adherence, adverse events, and health-related quality of life (HRQL) in paediatric CD. Three RCTs (n=76) and 16 cohort studies (n=1104) compared EEN versus CS. With limited available data (one RCT), the effect on intestinal microbiome indicated a trend toward EEN regarding Shannon diversity. Based on two RCTs, EEN achieved higher mucosal healing than CS (Risk Ratio [RR] 2.36, 95% confidence intervals (CI) 1.22 to 4.57, low certainty). Compared to CS, patients on EEN were less likely to experience adverse events based on two RCTs (RR 0.32, 95% CI 0.13 to 0.80, low certainty). For HRQL, there was a trend in favour of CS based on data from two published abstracts of cohort studies. Based on 13 cohort studies, EEN achieved higher clinical remission than CS (RR 1.18, 95% CI 1.02 to 1.38, very low certainty). Studies also reported no important differences in relapse and adherence. Compared to CS, EEN may improve mucosal healing with fewer adverse events based on RCT data. While limited data indicates the need for further trials, this is the first systematic review to comprehensively summarise the data on intestinal microbiome, mucosal healing and HRQOL when comparing enteral nutrition and CS in paediatric CD.

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The efficacy of total enteral nutrition in inducing remission and improving nutritional status in children with moderate to severe Crohn’s disease

Cited by 3 publications

References 20 publications

Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis

Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis

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

Microbiota signatures and mucosal healing in the use of enteral nutrition therapy v. corticosteroids for the treatment of children with Crohn’s disease: a systematic review and meta-analysis

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