Therapeutic Efficacy of Oral Enteral Nutrition in Pediatric Crohn's Disease: A Single Center Non-Comparative Retrospective Study

Abstract

PurposeExclusive enteral nutrition (EEN) therapy effectively induces clinical remission in Crohn's disease (CD). It remains unclear, however, whether partial enteral nutrition (PEN) can maintain remission. This study was performed to determine the abilities of oral EEN and oral PEN to induce and maintain clinical remission in pediatric patients with CD, respectively.Materials and MethodsPediatric patients with CD who received oral EEN at a single center in 2000–2014 were identified retrospectively. Remission rates of the EEN and PEN during the 2 years study period were determined. Risk factors for EEN and PEN failure were identified.ResultsOf the 66 patients who started EEN, 61 (92%) completed the course. Clinical remission was achieved in 88% (58/66) of the patients. All 58 patients with remission continued with PEN: 43 (74%) were treatment adherent. The cumulative remission rates at 1 and 2 years were 67% and 52%, respectively. Differing from EEN, limited therapeutic efficacy of PEN was shown in severe CD patients. Female gender associated significantly with non-adherence.ConclusionOral EEN and PEN effectively induced and maintained remission in a pediatric population. Non-adherence was a limiting factor in the success of therapy.

Inducing remission in paediatric Crohn’s disease using nutritional therapies – A systematic review

“…This was either 6 or 8 weeks, apart from one study that prescribed treatment for 4 weeks (40) The 4-week EEN protocol showed the lowest percentage of remission achieved (44%), with the highest rates of remission noted in a study applying an 8-week protocol (31) in which up to 90% of patients entered remission, although it was noted that the mean time until remission was only 6 weeks, with patients having been assessed every week. This was supported by the results obtained by Kim et al (33) who also found positive results on a 6-week protocol, with 88% of patients entering remission by this point. Unfortunately, a direct comparison of remission rates grouped to treatment duration was not possible, with all studies differing too significantly in other aspects of EEN protocol design.…”

“…In total, 16 studies met the inclusion criteria, with the key findings being summarised in Table 3. The majority of the studies identified were of a retrospective design, including three cohort studies (27)(28)(29) and eight uncontrolled cohort/case series studies (30)(31)(32)(33)(34)(35)(36)(37) The remaining five studies were prospective studies and included four RCTs (38)(39)(40)(41) and one uncontrolled study (42) Overall, the quality of studies included in this systematic review was weak, with 11 studies being rate as poor or very poor quality once study type was taken into consideration, with noncontrolled studies receiving a lower overall rating. Three studies were considered to be of moderate quality and one identified as good/high quality overall.…”

“…Disease activity and remission were based on the PCDAI (43) in most cases with remission assessed as PCDAI <10. However, three studies used currently nonvalidated tools to assess clinical remission, which was taken into consideration when assessing the overall quality rating of the study (27,30,37) Eleven studies assessed specific elements of enteral nutrition protocols, with six examining the effectiveness of different formula types (27,29,(39)(40)(41)(42) , one investigating the effectiveness of different routes of EEN administration (28) one looked at energy intakes/prescriptions in relation to clinical response (32) and three looked at use of a partial EN protocol (34,35,38) The remaining five studies included in the review examined EEN in general (30,31,33,36,37) No studies were identified that specifically examined the affect of varying protocol lengths on induction of remission.…”

“…A study comparing a glutamine enriched formula with a standard polymeric formula similarly found no difference in levels of remission or anthropometric measures although interestingly, a greater decline in mean PCDAI score was actually seen in the standard polymeric group (P = 0.002) (40) Eight further studies specified the type of formula used with their EEN protocol, although no control group was provideed for comparison and, apart from one study (42) the studies did not specifically aim to examine the efficacy of formula type. The three formula types used were elemental, standard polymeric and a Grogan et al (41) Low risk of bias High Gupta et al (35) Moderate quality No control group Low Johnson et al (38) Moderate risk of bias Moderate Kim et al (33) Moderate quality No control group Low Knight et al (36) Moderate quality No control group Low Ludvigsson et al (39) High risk of bias Deviation from study protocol in 1/3 of patients which was documented but not adjusted for Small sample size Low Rodrigues et al (27) Moderate quality Moderate Rubio et al (28) Moderate quality Moderate Sigall-Boneh et al (34) Moderate quality No control group Low CS, Crohn's corticosteroids; EEN, exclusive enteral nutrition. *Downgraded À 1 for each weakness noted, +1 if Randomised controlled trial.…”

Modifiable Environmental Factors in Inflammatory Bowel Disease

“…47 A single center retrospective study evaluating PEN after inducing remission with EEN in pediatric patients revealed that among 58 patients (out of 66) who were continued on PEN, only forty-three patients were adherent and cumulative remission rates at 1 and 2 years were 67% and 52% respectively. 48 …”