Related Experiment Video
Updated: Mar 24, 2026
Tissue Engineering of the Intestine in a Murine Model
Published on: December 1, 2012
Early Mucosal Healing with Exclusive Enteral Nutrition is Associated with Improved Outcomes in Newly Diagnosed
Z Grover1, C Burgess2, R Muir3
1Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, Australia Department of Gastroenterology, Queensland Children Medical Research institute, Brisbane, Australia zubin.grover@health.wa.gov.au.
Insights
Exclusive Enteral Nutrition (EEN) for pediatric Crohn's disease (CD) leads to early mucosal healing (MH). Complete MH after EEN is crucial for sustained remission (SR) on immunomodulators alone for up to three years.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Mucosal Healing in Crohn's Disease
Background:
- Exclusive Enteral Nutrition (EEN) is effective for inducing early mucosal healing (MH) in pediatric Crohn's disease (CD).
- Long-term benefits of EEN-induced MH in children with CD require further investigation.
Purpose of the Study:
- To prospectively evaluate the long-term sustained remission (SR) in children with CD following EEN induction.
- To determine if early mucosal healing (MH) achieved through EEN predicts sustained remission on immunomodulators alone.
Main Methods:
- Prospective follow-up of newly diagnosed pediatric CD patients completing EEN.
- Assessment of clinical (PCDAI), biochemical (CRP), and endoscopic (SES-CD) parameters at diagnosis and post-EEN.
- Primary outcome: SR on immunomodulators without corticosteroids, infliximab, or surgery for at least 1 year.
Main Results:
- Complete mucosal healing (MH) (SES-CD=0) was achieved in 33% of patients post-EEN.
- Sustained remission (SR) at 1, 2, and 3 years was significantly higher in patients with complete MH compared to those with active endoscopic disease (aED).
- Near-complete MH did not result in superior SR compared to aED.
Conclusions:
- Complete mucosal healing (MH) following Exclusive Enteral Nutrition (EEN) induction is a key predictor of sustained remission in pediatric Crohn's disease.
- Achieving complete MH is essential for favorable long-term outcomes in children treated with EEN and immunomodulators.
Background:
Exclusive Enteral Nutrition (EEN) induction in children with luminal Crohn's disease (CD) gives early mucosal healing (MH), but the long-term benefits of EEN-induced MH are just emerging.
Aims & Methods:
We prospectively followed an Australian cohort of newly diagnosed children with predominantly luminal CD who completed at least six weeks EEN and with paired clinical Pediatric Crohn's Disease Activity Index (PCDAI), biochemical (C-reactive protein; CRP) and endoscopic assessment at diagnosis and post EEN. All commenced immunomodulators (IMs) early (<3 months from diagnosis) and had a minimum of 1 year follow-up. Complete MH was a simple endoscopic score for Crohn's disease (SES-CD) of 0, and SES-CD≥1 was ascribed to active endoscopic disease (aED) and further divided into near complete MH (SES 1-3), mild active disease (SES-CD 4-10) and moderate to severe disease (SES-CD>10). The primary outcome was long-term supervised sustained remission (SR) on IMs alone without need for corticosteroids, infliximab (IFX) or surgery.
Results:
A total of 54 eligible children (33 males) completing EEN induction were analysed. The median duration between pre and post EEN assessments was 60.5 days [interquartile range (IQR), 56-69.5]. Post EEN: clinical remission (PCDAI < 10) was observed in 45/54 (83%), and biochemical remission (PCDAI < 10 and CRP < 5 mg/dl) was observed in 39/54 (72%). Complete MH was observed in 18/54 (33%), near complete in 10/54(19%). SR was superior in those with complete MH vs. aED; 13/18, (72%) vs. 10/36 (28%), p = 0.003 at 1 year, 8/16, (50%) vs. 3/24, (8%), p = 0.008 at 2 years and (8/16, (50%) vs. 1/19, (6%), p = 0.005) at 3 years. Near-complete MH did not lead to superior SR.
Conclusions:
Only complete MH post EEN induction predicts more favourable SR for up to 3 years.
More Related Videos
07:05Important Endpoints and Proliferative Markers to Assess Small Intestinal Injury and Adaptation using a Mouse Model of Chemotherapy-Induced Mucositis
Published on: May 12, 2019
09:36Effect of Hyaluronic Acid 35 kDa on an In Vitro Model of Preterm Small Intestinal Injury and Healing Using Enteroid-Derived Monolayers
Published on: July 28, 2022
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:24Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:25Peptic Ulcer Disease V: Surgical Management and Nursing Care
Surgical Interventions for Peptic Ulcer Disease