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Nutritional Therapy in Very Early-Onset Inflammatory Bowel Disease: A Case Report
Talya L Miller1, Dale Lee2, Mathew Giefer2
1Department of Pediatrics, Seattle Children's Hospital and University of Washington, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA. talya.miller@seattlechildrens.org.
Insights
Exclusive enteral nutrition achieved clinical remission in infants with very early-onset inflammatory bowel disease (VEO-IBD). This formula-based diet shows promise for treating severe pediatric VEO-IBD refractory to conventional therapies.
Area of Science:
- Pediatric Gastroenterology
- Immunology
- Nutritional Science
Background:
- Very early-onset inflammatory bowel disease (VEO-IBD) affects children under 6 years, often presenting with severe, aggressive disease and poor treatment response.
- VEO-IBD can be refractory to standard therapies and is sometimes linked to underlying immunodeficiencies or specific genetic mutations.
- The efficacy of nutritional therapies in VEO-IBD remains largely unestablished, despite their use in older pediatric IBD patients.
Observation:
- Two infants with VEO-IBD, characterized by severe colonic inflammation and refractoriness to medical treatment, were studied.
- These infants presented with aggressive disease behavior distinct from older IBD patients.
- Genetic factors and potential immunodeficiencies were considered in the context of VEO-IBD presentation.
Findings:
- Both infants achieved complete clinical remission through exclusive enteral nutrition (EEN).
- EEN, a formula-based diet, was implemented as the primary therapeutic intervention.
- The study highlights the successful application of EEN in a challenging VEO-IBD population.
Implications:
- Exclusive enteral nutrition may represent a viable and effective therapeutic option for infants with severe VEO-IBD.
- This approach could offer an alternative for VEO-IBD patients unresponsive to conventional medical or immunosuppressive treatments.
- Further research into nutritional therapies for VEO-IBD is warranted to establish their role in managing this complex pediatric condition.
Abstract:
Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract caused by a dysregulated immune response to the fecal microbiota. Very early-onset inflammatory bowel disease (VEO-IBD) refers to a subgroup of pediatric patients with IBD diagnosed before 6 years of age. This subgroup is often characterized by increased severity, aggressive progression, strong family history of IBD, and often poor response to conventional treatments. Nutritional therapies have been utilized to treat IBD, but their role in VEO-IBD is unclear. Disease behavior in VEO-IBD is often different from disease in adolescents and adults, as it is often restricted to the colon and refractory to standard medical therapies. Up to 25% of VEO-IBD patients have an identified underlying immunodeficiency, which may impact response to therapy. While specific mutations in interleukin 10 (IL-10), the IL-10 receptor (IL-10R), and mutations in NCF2, XIAP, LRBA, and TTC7 have been identified in VEO-IBD, polymorphisms in these genes are also associated with increased risk of developing IBD in adolescence or adulthood. We describe two cases in which infants presenting with VEO-IBD achieved clinical remission using exclusive enteral nutrition, a formula-based diet which has been shown to induce remission in older children with active Crohn's disease.
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