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Outcomes of exclusive enteral nutrition in paediatric Crohn's disease
L Lafferty1,2, M Tuohy1,2, A Carey2,3
1Dublin Institute of Technology, Dublin, Ireland.
Insights
Exclusive enteral nutrition (EEN) is more effective than corticosteroid (CS) therapy for inducing remission in pediatric Crohn's disease (CD). EEN shows higher remission rates, particularly when used as an initial treatment for patients over 10 years old.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Nutrition
Background:
- Paediatric Crohn's disease (CD) management often involves exclusive enteral nutrition (EEN) or corticosteroid (CS) therapy.
- EEN is recognized as a safe and effective method for inducing remission in pediatric CD.
- This study aimed to compare EEN and CS outcomes in newly diagnosed, treatment-naïve pediatric CD patients.
Purpose of the Study:
- To compare the efficacy of exclusive enteral nutrition (EEN) versus corticosteroid (CS) therapy in inducing remission in pediatric Crohn's disease.
- To evaluate the long-term outcomes of EEN in a national cohort of pediatric CD patients over a 10-year period.
- To identify factors influencing treatment success in pediatric CD.
Main Methods:
- Retrospective chart review at a national referral center for pediatric CD.
- Case-matched analysis comparing EEN and CS cohorts (matched for age, gender, disease location, behavior, and activity).
- Cohort analysis of all pediatric CD patients who underwent EEN between 2004 and 2013.
Main Results:
- Higher remission rates were observed with EEN (86%) compared to CS (54%) in the case-matched analysis (P=0.02).
- Dietetic support was crucial for successful EEN treatment and remission.
- In the cohort analysis, 69% of patients achieved clinical remission with EEN; it was most effective as initial therapy (P=0.004) and in patients over 10 years old (P=0.04).
Conclusions:
- Exclusive enteral nutrition (EEN) is a favorable primary treatment option for pediatric Crohn's disease, outperforming corticosteroids.
- EEN is particularly recommended as a first-line therapy for newly diagnosed pediatric CD patients over 10 years of age.
- The findings support the consideration of EEN as a primary treatment strategy over corticosteroids for pediatric CD.
Background/Objectives:
Exclusive enteral nutrition (EEN) is a safe and effective treatment modality for inducing remission in paediatric Crohn's disease (CD). The primary aim of this study was to compare the outcomes of EEN to corticosteroid (CS) therapy in newly diagnosed, treatment-naïve patients with CD. A secondary aim was to describe the outcomes of EEN in a national cohort of paediatric CD patients over a 10-year period.
Subjects/Methods:
A retrospective chart review was conducted at the Irish national referral centre for paediatric CD. A case-matched analysis was conducted on two cohorts matched for age, gender, disease location, disease behaviour and disease activity, who received CS or EEN as their initial treatment. Subsequently, cohort analysis was conducted on all patients who undertook a course of EEN therapy between 2004 and 2013.
Results:
The case-matched analysis found higher remission rates after treatment with EEN (24/28, 86%) compared with those with CS (15/28, 54%; P=0.02). Dietetic contacts were found to be pivotal to the success of treatment and the attainment of remission. In total, 59 patients completed EEN at some time-point in their disease course and were included in the cohort analysis. Sixty-nine per cent of this cohort entered clinical remission (41/59). EEN was found to be most effective when used as an initial treatment (P=0.004) and less effective in patients aged under 10 years (P=0.04).
Conclusions:
EEN should be strongly considered as a favourable primary treatment over CS, especially in those diagnosed over the age of 10 years.
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