Efficacy of Exclusive Enteral Nutrition in Pediatric Crohn’s Disease
DOI:
https://doi.org/10.12873/412rodriguesPalabras clave:
Crohn’s disease, Exclusive enteral nutrition, PediatricsResumen
Introduction: Exclusive enteral nutrition (EEN) is recommended as first line therapy for mild to moderate Crohn’s disease (CD) to induce remission in pediatric patients. It involves the use of a whole protein formula given exclusively for six to eight weeks.
Aims: To report the preliminary experience of a tertiary care center in Portugal, concerning the efficacy and tolerance of EEN in pediatric patients with CD.
Materials and methods: Retrospective descriptive study of pediatric CD patients who received EEN as induction of remission therapy between January/2014 and June/2019. Clinical and laboratory parameters were assessed, including clinical disease activity and nutritional status before and immediately after treatment.
Results: In the study period, 37 patients were diagnosed with CD; 19 were included in the study, 17/19 (89.5%) completed the EEN therapy and 16/17 (94%) achieved clinical remission. Ten patients were male, with a median age of 14.2 years (range 8.6-17.9 years). The majority of the patients had ileocolonic disease (47.4%) or ileocecal disease (42.1%) and an inflammatory behavior (78.9%). None of the patients had growth delay at diagnosis. All patients received EEN orally for six to eight weeks, 18 used polymeric formulas and one used an elemental formula. Comparing data at baseline and after treatment, significant improvements were observed in BMI Z-score (p=0.002), PCDAI score (p<0.001), erythrocyte sedimentation rate (p=0.002), C-reactive protein (p=0.003), faecal calprotectin concentration (p=0.036), and serum albumin (p=0.020). No side effects were noticed.
Discussion/Conclusion: In this series, EEN therapy was associated to significant improvement of disease activity index, nutritional status, weight gain and decreased markers of inflammation in most patients. Our data are in accordance with previous observations that EEN is an effective and well tolerated treatment for the induction of remission in pediatric patients with CD.
Citas
Logan M, Clark CM, Ijaz UZ, Gervais L, Duncan H, Garrick V, et al. The reduction of faecal calprotectin during exclusive enteral nutrition is lost rapidly after food re‐introduction. Aliment Pharmacol Ther. 2019 Sep;50(6):664-674. doi: 10.1111/apt.15425.
Day AS, Lopez RN. Exclusive enteral nutrition in children with Crohn's disease. World J Gastroenterol. 2015 Jun;21(22):6809-16. doi: 10.3748/wjg.v21.i22.6809.
Yu Y, Chen KC, Chen J. Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn’s disease: a meta-analysis. World J. Pediatr. 2019 Feb;15(1):26-36. doi: 10.1007/s12519-018-0204-0.
Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis. 2014 Oct;8(10):1179-207. doi: 10.1016/j.crohns.2014.04.005.
Critch J, Day AS, Otley A, King-Moore C, Teitelbaum JE, Shashidhar H; NASPGHAN IBD Committee. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2012 Feb;54(2):298-305. doi: 10.1097/MPG.0b013e318235b397.
Forbes A, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, et al. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clin Nutr. 2017 Apr;36(2):321-347. doi: 10.1016/j.clnu.2016.12.027.
Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. ESPGHAN revised Porto criteria for the diagnosis of inflammatory disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014 Jun;58(6):795-806. doi: 10.1097/MPG.0000000000000239.
Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russell RK, et al. Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011 Jun;17(6):1314-21. doi: 10.1002/ibd.21493.
Turner D, Griffiths AM, Walters TD, Seah T, Markowitz J, Pfefferkorn M, et al. Mathematical weighting of the pediatric Crohn's disease activity index (PCDAI) and comparison with its other short versions. Inflamm Bowel Dis. 2012 Jan;18(1):55-62. doi: 10.1002/ibd.21649.
Gasparetto M, Guariso G. Crohn's disease and growth deficiency in children and adolescents. World J Gastroenterol. 2014 Oct 7;20(37):13219-33. doi: 10.3748/wjg.v20.i37.13219.
Levine A, Turner D, Pfeffer Gik T, Amil Dias J, Veres G, Shaoul R, et al. Comparison of outcomes parameters for induction of remission in new onset pediatric Crohn's disease: evaluation of the Porto IBD group "growth relapse and outcomes with therapy" (GROWTH CD) study. Inflamm Bowel Dis. 2014 Feb;20(2):278-85. doi: 10.1097/01.MIB.0000437735.11953.68.
Swaminath A, Feathers A, Ananthakrishnan AN, Falzon L, Li Ferry S. Systematic review with meta-analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease. Aliment Pharmacol Ther. 2017 Oct;46(7):645-656. doi: 10.1111/apt.14253.
Kang Y, Park S, Kim S, Kim SY, Koh H. Therapeutic Efficacy of Exclusive Enteral Nutrition with Specific Polymeric Diet in Pediatric Crohn's Disease. Pediatr Gastroenterol Hepatol Nutr. 2019 Jan;22(1):72-79. doi: 10.5223/pghn.2019.22.1.72.
Scarpato E, Strisciuglio C, Martinelli M, Russo M, Cenni S, Casertano M, et al. Exclusive enteral nutrition effect on the clinical course of pediatric Crohn's disease: a single center experience. Eur J Pediatr. 2020 Dec;179(12):1925-1934. doi: 10.1007/s00431-020-03753-x.
Ashton JJ, Gavin J, Beattie RM. Exclusive enteral nutrition in Crohn’s disease: Evidence and practicalities. Clin Nutr. 2019 Feb;38(1):80-89. doi: 10.1016/j.clnu.2018.01.020.
MacLellan A, Moore-Connors J, Grant S, Cahill L, Langille MGI, Van Limbergen J. The impact of Exclusive Enteral Nutrition (EEN) on the Gut Microbiome in Crohn's Disease: A Review. Nutrients. 2017 May 1;9(5):447. doi: 10.3390/nu9050447.
Diederen K, Li JV, Donachie GE, de Meij TG, de Waart DR, Hakvoort TBM, et al. Exclusive enteral nutrition mediates gut microbial and metabolic changes that are associated with remission in children with Crohn's disease. Sci Rep. 2020 Nov 3;10(1):18879. doi: 10.1038/s41598-020-75306-z.
Levine A, Wine E, Assa A, Sigall Boneh R, Shaoul R, Kori M, et al. Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology. 2019 Aug;157(2):440-450.e8. doi: 10.1053/j.gastro.2019.04.021.
Svolos V, Hansen R, Nichols B, Quince C, Ijaz UZ, Papadopoulou RT, et al. Treatment of Active Crohn's Disease With an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology. 2019 Apr;156(5):1354-1367.e6. doi: 10.1053/j.gastro.2018.12.002.
Kim HJ, Kim Y, Cho JM, Oh SH, Kim KM. Therapeutic Efficacy of Oral Enteral Nutrition in Pediatric Crohn’s Disease: A Single Center Non-Comparative Retrospective Study. Yonsei Med J. 2016 Sep;57(5):1185-91. doi: 10.3349/ymj.2016.57.5.1185.
Bie C, Kindermann A, Escher J. Use of exclusive enteral nutrition in paediatric Crohn's disease in the Netherlands. J Crohns Colitis. 2013 May;7(4):263-70. doi: 10.1016/j.crohns.2012.07.001.
Miele E, Shamir R, Aloi M, Assa A, Braegger C, Bronsky J, et al. Nutrition in Paediatric Inflammatory Bowel Disease: A Position Paper on Behalf of The Porto IBD Group of ESPGHAN. J Pediatr Gastroenterol Nutr. 2018 Jan;66(4):687-708. doi: 10.1097/MPG.0000000000002092.
Adamji M, Day AS. An overview of the role of exclusive enteral nutrition for complicated Crohn's disease. Intest Res. 2019 Apr;17(2):171-176. doi: 10.5217/ir.2018.00079.
Gerasimidis K, Talwar D, Duncan A, Moyes P, Buchanan E, Hassan K, et al. Impact of exclusive enteral nutrition on body composition and circulating micronutrients in plasma and erythrocytes of children with active Crohn's disease. Inflamm Bowel Dis. 2012 Sep;18(9):1672-81. doi: 10.1002/ibd.21916.
Shaikhkhalil AK, Crandall W. Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy. Nutr Clin Pract. 2018 Aug;33(4):493-509. doi: 10.1002/ncp.10011.
Chen JM, He LW, Yan T, Guo XF, Hu PJ, Peng JS, et al. Oral exclusive enteral nutrition induces mucosal and transmural healing in patients with Crohn's disease. Gastroenterol Rep (Oxf). 2019 Jun;7(3):176-184. doi: 10.1093/gastro/goy050.
Lafferty L, Tuohy M, Carey A, Sugrue S, Hurley M, Hussey S. Outcomes of exclusive enteral nutrition in paediatric Crohn's disease. Eur J Clin Nutr. 2017 Feb;71(2):185-191. doi: 10.1038/ejcn.2016.210.
Narula N, Dhillon A, Zhang D, Sherlock ME, Tondeur M, Zachos M. Enteral nutritional therapy for induction of remission in Crohn's disease. Cochrane Database Syst Rev. 2018 Apr 1;4:CD000542. doi: 10.1002/14651858.CD000542.pub3.
Svolos V, Gerasimidis K, Buchanan E, Curtis L, Garrick V, Hay J, et al. Dietary treatment of Crohn's disease: perceptions of families with children treated by exclusive enteral nutrition, a questionnaire survey. BMC Gastroenterol. 2017 Jan 19;17(1):14. doi: 10.1186/s12876-016-0564-7.
Wiskin AE, Haggarty R, Afzal NA, Batra A, Wootton SA, Beattie RM. Nutritional perspectives of children with Crohn's disease: a single-centre cohort observation of disease activity, energy expenditure and dietary intake. Eur J Clin Nutr. 2016 Oct;70(10):1132-1137. doi: 10.1038/ejcn.2016.107.
Descargas
Publicado
Cómo citar
Licencia
Derechos de autor 2021 Nutrición Clínica y Dietética Hospitalaria
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Los lectores pueden utilizar los textos publicados de acuerdo con la definición BOAI (Budapest Open Access Initiative)
