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Erschienen in: Journal of Gastroenterology 4/2014

01.04.2014 | Original Article—Alimentary Tract

Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn’s disease

verfasst von: Zubin Grover, Richard Muir, Peter Lewindon

Erschienen in: Journal of Gastroenterology | Ausgabe 4/2014

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Abstract

Background and aims

Exclusive enteral nutrition (EEN) induces clinical and mucosal healing (MH) in Crohn’s disease (CD), with MH the best determinant of future outcome. We investigated efficacy of EEN for inducing early clinical, biochemical, mucosal and transmural remission of CD and related early endoscopic response to outcomes at 1 year.

Methods

In a prospective, open label study 34 children (mean 13.1 years; 21 males) with new diagnosis CD were offered EEN, 26 completed a minimum 6 weeks EEN and underwent paired clinical, biochemical and endoscopic assessment at start and completion using PCDAI, BMI, CRP and Simple Endoscopic Score for CD (SES-CD). A subset, 16/26, had paired MR enterography scored. Early good endoscopic response (complete MH, or near complete, SES-CD 0–3) was related to outcome at 1 year.

Results

EEN improved mean PCDAI (37.88–7.01, p < 0.001; BMI Z scores (−1.54 to −0.54, p < 0.01); weight Z score (−0.79 to −0.08, p < 0.03); CRP (44.86–5.5, p < 0.001); endoscopy (SES-CD 14.28–3.88, p < 0.001) and MRE (5.14–2.79, p = 0.01). Of 26 children, 22 (84 %) achieved clinical remission; 20 (76 %) biochemical remission. Fifteen (58 %) had early good endoscopic response (11 complete, 4 near complete MH) and 3/14 (21 %) had complete transmural remission of ileal CD (MRE-CD: 0–1). Early good endoscopic response was associated with reduced endoscopic confirmed relapse (53 vs. 100 %, p = 0.02), anti-TNF use (33 vs. 88 %, p = 0.01) and hospitalisation (40 vs. 88 %) at 1 year.

Conclusions

EEN is effective for inducing early clinical, biochemical, mucosal and transmural remission. Early endoscopic remission improves outcomes at 1 year.
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Metadaten
Titel
Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn’s disease
verfasst von
Zubin Grover
Richard Muir
Peter Lewindon
Publikationsdatum
01.04.2014
Verlag
Springer Japan
Erschienen in
Journal of Gastroenterology / Ausgabe 4/2014
Print ISSN: 0944-1174
Elektronische ISSN: 1435-5922
DOI
https://doi.org/10.1007/s00535-013-0815-0

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