The role and efficacy of exclusive enteral nutrition (EEN) in the treatment of luminal Crohn’s disease (CD) has been well established over the last 2 decades. Consequently, in many centers nutritional therapy is now considered first line therapy in the induction of remission of active CD. However, the use of nutritional therapy in complicated CD has yet to be fully determined. This article aimed to review case reports and clinical trials published in the last decade that have considered and evaluated nutritional therapy in the setting of complicated CD in children and adults. Published literature focusing upon the use of nutritional therapy as part of medical therapy in the management of complicated CD were identified and reviewed. Although there continue to be various interventions utilized for complicated CD, the currently available literature demonstrates that nutritional therapies, especially EEN, have important roles in the management of these complex scenarios. Further assessments, involving large numbers of patients managed with consistent approaches, are required to further substantiate these roles.

Background: High-dose oral vitamin D (stoss) is a novel treatment in children with inflammatory bowel disease (IBD). Vitamin D supplementation may have benefits in IBD beyond bone health including reduced disease activity and improvements in inflammatory markers. The aim of this study was to retrospectively assess the efficacy, safety and impact on disease activity of single oral high-dose vitamin D3 therapy in New Zealand (NZ) children with IBD and vitamin D deficiency. Methods: In this retrospective chart review, children with IBD and vitamin D deficiency [serum 25-OH vitamin D level (25-OHD) <50 nmol/L] in Christchurch, NZ, who were managed with single highdose vitamin D3 therapy were identified. Measurements of serum 25-OHD, calcium and standard serum inflammatory markers prior to and up to 6 months following stoss therapy were extracted from patient records. Disease activity was also defined using the Pediatric Crohn's Disease (CD) Activity Index (PCDAI) at time points before and 3 months following stoss. Results: Twenty-eight doses of stoss were given to 23 children, aged 3-16 years. Mean 25-OHD levels

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RESULTS:Over the study period, 110 children were diagnosed at mean age of 7.37 years. The most common presenting symptom was abdominal pain. Sixteen children were diagnosed following screening in high risk groups, with 14 being asymptomatic. Eighteen children were iron deficient and twelve vitamin D deficient. CONCLUSIONS: CD was diagnosed in children of all ages, with various presentation patterns. Micronutrient deficiencies were commonly seen at diagnosis. Ongoing assessment of patterns of CD in NZ children is required. INTRODUCTIONCoeliac disease (CD) is an autoimmune disease of the small bowel, triggered by dietary exposure to gluten in genetically susceptible individuals [1] . Ingestion of gluten provokes immune-mediated damage to the small intestinal mucosa. The optimal management of CD currently involves institution of a life-long gluten free diet (GFD) [2] . The features of CD can develop at any age whilst on a gluten containing diet [3] . CD can have variable presentations from gastrointestinal symptoms to non-specific symptoms such as headaches or lethargy [4][5][6] . In addition, many individuals are increasingly identified consequent to active screening in groups at higher risk of CD (such as those with positive family history or type 1 diabetes) and a number of these individuals may be asymptomatic at diagnosis [7] . CD appears to be increasing in prevalence in many countries around the world, including New Zealand [7] . A population-based study conducted in the Christchurch region of New Zealand in the last years of the 20 th century using electoral roll records, showed a prevalence of 1.2% [8] . A further study in the same region documented more individuals being diagnosed with CD each year [9] . Subsequently AIM:To evaluate the presentation patterns of a cohort of children diagnosed with coeliac disease at Christchurch Hospital, New Zealand. METHODS: Children aged 15 years or less diagnosed with CD (based upon standard histological criteria) over a five year period were identified retrospectively. Presenting symptoms, anthropometry, serology and micronutrients were reviewed.