Exclusive enteral nutrition continues to be first line therapy for pediatric Crohn's disease in the era of biologics

Navas-López, Víctor Manuel; Blasco‐Alonso, Javier; Maseri, S. Lacasa; Fernández-Crehuet, F. Girón; Nieto, María Juliana Serrano; Recio, M.I. Vicioso; Salinas, C. Sierra

doi:10.1016/j.anpede.2014.02.005

Cited by 11 publications

(10 citation statements)

References 39 publications

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“…Recently exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing for paediatric CD sufferers (314) . Navas-López et al (314) found that EEN administered for 6-8 weeks was effective in decreasing mucosal inflammation and inducing clinical remission. Although several studies have demonstrated the efficacy of EEN as a maintenance therapy, the long-term effectiveness of EEN has not been investigated fully.…”

Section: Current Therapymentioning

confidence: 99%

“…Recently exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing for paediatric CD sufferers ( 314 ) . Navas-López et al .…”

Section: Current Therapymentioning

confidence: 99%

“…Navas-López et al . ( 314 ) found that EEN administered for 6–8 weeks was effective in decreasing mucosal inflammation and inducing clinical remission. Although several studies have demonstrated the efficacy of EEN as a maintenance therapy, the long-term effectiveness of EEN has not been investigated fully.…”

Section: Current Therapymentioning

confidence: 99%

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Intestinal barrier dysfunction: implications for chronic inflammatory conditions of the bowel

Miner-Williams

Moughan

2016

Nutr. Res. Rev.

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The intestinal epithelium of adult humans acts as a differentially permeable barrier that separates the potentially harmful contents of the lumen from the underlying tissues. Any dysfunction of this boundary layer that disturbs the homeostatic equilibrium between the internal and external environments may initiate and sustain a biochemical cascade that results in inflammation of the intestine. Key to such dysfunction are genetic, microbial and other environmental factors that, singularly or in combination, result in chronic inflammation that is symptomatic of inflammatory bowel disease (IBD). The aim of the present review is to assess the scientific evidence to support the hypothesis that defective transepithelial transport mechanisms and the heightened absorption of intact antigenic proinflammatory oligopeptides are important contributing factors in the pathogenesis of IBD.

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Section: Current Therapymentioning

confidence: 99%

“…Recently exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing for paediatric CD sufferers ( 314 ) . Navas-López et al .…”

Section: Current Therapymentioning

confidence: 99%

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Intestinal barrier dysfunction: implications for chronic inflammatory conditions of the bowel

Miner-Williams

Moughan

2016

Nutr. Res. Rev.

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“…The use of EN for maintenance of remission varies across IBD centres in terms of strategies used (eg, overnight versus supplemental day time, percentage of total daily calories, as monotherapy or in combination with immunomodulators/anti-TNF) (10,12,15,(32)(33)(34)(35)(36)(37). Research is ongoing with regard to the optimal maintenance strategy (eg, Cyclic Exclusive Enteral Nutrition as Maintenance Therapy for Pediatric Crohn's Disease [CD-HOPE; NCT02201693] by GETAID pédiatrique) but uncertainty with regard to its use during maintenance of remission could deter from using EEN as induction therapy.…”

Section: Vers L'alimentation Entérique Pour Le Traitement De La Maladmentioning

confidence: 99%

Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers

Limbergen

Haskett

Griffiths

et al. 2015

Canadian Journal of Gastroenterology and Hepatology

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The treatment armamentarium in pediatric Crohn disease (CD) is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet]), which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario), inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies). Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

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“…Mucosal healing has been correlated with reduced risk of disease relapse, for example [ 20 ]. Steroids do not effectively induce mucosal healing, but several studies have shown that EEN can [ 21 , 22 , 23 , 24 ]. Borrelli et al demonstrated in a randomized controlled trial of 37 children with CD that EEN induced mucosal healing in a greater proportion of patients compared to corticosteroids ( p < 0.001) at 10 weeks.…”

Section: Treatment Of CD With Eenmentioning

confidence: 99%

Microbiome Associations of Therapeutic Enteral Nutrition

Shah

Kellermayer

2014

Nutrients

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One of the most effective forms of therapeutic enteral nutrition is designated as “exclusive enteral nutrition” (EEN). EEN constitutes the monotonous enteral delivery of complete liquid nutrition and has been most explored in the treatment Crohn’s disease (CD), a form of inflammatory bowel disease. While EEN’s mechanisms of action are not clearly understood, it has been shown to modify the composition of the intestinal microbiome, an important component of CD pathogenesis. The current literature on the intestinal microbiome in healthy individuals and CD patients is reviewed with respect to EEN therapy. Further investigations in this field are needed to better understand the role and potential for EEN in chronic human disorders.

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Exclusive enteral nutrition continues to be first line therapy for pediatric Crohn's disease in the era of biologics

Cited by 11 publications

References 39 publications

Intestinal barrier dysfunction: implications for chronic inflammatory conditions of the bowel

Intestinal barrier dysfunction: implications for chronic inflammatory conditions of the bowel

Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers

Microbiome Associations of Therapeutic Enteral Nutrition

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