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Exclusive enteral nutrition in children with inflammatory bowel disease: Physician perspectives and practice
1Department of Paediatrics University of Otago Christchurch New Zealand.
Insights
Pediatric gastroenterologists in Australia and New Zealand widely accept exclusive enteral nutrition (EEN) for pediatric Crohn's disease (CD) remission. However, EEN protocols and its use in other inflammatory bowel diseases (IBD) show variation.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Nutritional Therapy
Background:
- Exclusive enteral nutrition (EEN) is a primary treatment for pediatric Crohn's disease (CD).
- A prior survey indicated significant skepticism among Australian pediatric gastroenterologists regarding EEN for CD.
- Current attitudes towards EEN in pediatric inflammatory bowel disease (IBD) in Australasia require updated investigation.
Purpose of the Study:
- To assess current Australian and New Zealand pediatric gastroenterologists' attitudes towards using EEN for pediatric IBD.
- To identify trends and variations in EEN application and protocols in the region.
Main Methods:
- An anonymous online questionnaire was distributed to all practicing pediatric gastroenterologists in Australia and New Zealand.
- The survey targeted current perceptions and practices regarding EEN in pediatric IBD management.
Main Results:
- A 54% response rate yielded 37 participants (31 Australian, 6 New Zealander).
- All respondents affirmed EEN's role in inducing remission for newly diagnosed CD.
- Australian specialists were more inclined to use EEN for relapsed CD or IBD-unclassified compared to New Zealand counterparts.
- Adherence challenges were identified as the primary drawback of EEN, with dietitians crucial for its administration.
Conclusions:
- Pediatric gastroenterologists in Australasia now widely support EEN for inducing remission in pediatric CD.
- Perceptions of EEN's utility in other IBD types and variations in EEN protocols persist across centers.
- Attitudes towards EEN in pediatric IBD have significantly evolved over the past decade in the region.
Background And Aim:
Exclusive enteral nutrition (EEN) is recognized internationally as the first line of treatment for children with active Crohn's disease (CD). A survey conducted a decade ago demonstrated that 40% of Australian pediatric gastroenterologists did not think EEN to be an appropriate treatment for CD. This study aimed to explore the current attitudes of Australian and New Zealand (NZ) pediatric gastroenterologists toward the use of EEN in children with inflammatory bowel disease (IBD).
Methods:
All practicing pediatric gastroenterologists in Australia and NZ were invited via an existing email network to complete an anonymous online questionnaire.
Results:
The questionnaire was completed by 37 respondents (54% response rate), 31 from Australia and 6 from NZ. All respondents felt that EEN definitely or probably has a role in inducing remission for children with newly diagnosed CD. Australian gastroenterologists were more likely to use EEN for relapsed CD or IBD-unclassified than NZ doctors (P < 0.05). Adherence was reported to be the greatest disadvantage of EEN. Dietitians were believed to play the most crucial role in EEN administration. Variations in EEN protocols included the use of flavorings or fluids during EEN and different patterns of food reintroduction.
Conclusions:
These Australia and NZ pediatric gastroenterologists felt that EEN plays an important role in the induction of remission in children with newly diagnosed CD. However, the perceived role of EEN use in other types of IBD varied. EEN protocols varied widely between centers. Attitudes toward the roles of EEN have altered greatly across Australasia over the last decade.
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