Exclusive enteral nutrition effect on the clinical course of pediatric Crohn’s disease: a single center experience

Scarpato, Elena; Strisciuglio, Caterina; Martinelli, Massimo; Russo, Marina; Cenni, Sabrina; Casertano, Marianna; Serra, Maria Rosaria; Staiano, Annamaria; Miele, Erasmo

doi:10.1007/s00431-020-03753-x

Cited by 7 publications

(21 citation statements)

References 31 publications

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“…faecal calprotectin, C-reactive protein, and Paediatric CD Activity Index (PCDAI)). 18,19 In a Cochrane study, comparing EEN to CS for remission induction in paediatric patients with active CD, EEN remission rates were 63-83% compared to 61-72% with CS, and no statistical difference was found. 13 Four studies identified a significantly higher rate of mucosal healing in children who received EEN as induction therapy, compared to CS.…”

Section: Remission Inductionmentioning

confidence: 99%

Exclusive enteral nutrition: An optimal care pathway for use in children with active luminal Crohn's disease

Burgess

McGrath

Watson

et al. 2022

J Paediatrics Child Health

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Exclusive enteral nutrition (EEN) is recommended as a first-line therapy for active luminal paediatric Crohn's disease, by many contemporary consensus guidelines. However, EEN protocols vary internationally. A key enabler for the use of EEN therapy has been identified as the standardisation of protocols. The aim of this study was to develop an optimal care pathway for use of EEN in children with active luminal Crohn's disease. Methods: A working group of 11 paediatric gastroenterology dietitians and one paediatric gastroenterologist from Australia and New Zealand was convened to develop a standard optimal care pathway. Seven key areas were identified; clinical indications, workup assessments, EEN prescription, monitoring, food reintroduction, partial enteral nutrition and maintenance enteral nutrition. Recent literature was reviewed, assessed according to the National Health and Medical Research Council guidelines, and consensus statements were developed and voted on. Consensus opinion was used where literature gaps existed. Results: A total of nineteen consensus statements from the seven key areas were agreed upon. The consensus statements informed the optimal care pathway for children with active luminal undertaking EEN in Australia and New Zealand. Conclusion: This study developed an EEN optimal care pathway to facilitate standardisation of clinical care for children with active luminal Crohn's disease, and hopefully improve clinical outcomes and identify areas for future research.

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Section: Remission Inductionmentioning

confidence: 99%

Exclusive enteral nutrition: An optimal care pathway for use in children with active luminal Crohn's disease

Burgess

McGrath

Watson

et al. 2022

J Paediatrics Child Health

View full text Add to dashboard Cite

show abstract

“…In this issue of the European Journal of Pediatrics, two studies in real-life experience cohorts are published. Scarpato et al compare the effects of exclusive enteral nutrition (EEN) versus corticosteroids as remission therapy on several shortand long-term outcomes in 68 children with Crohn's disease using historical data (2003-2013) from their center [4]. Jongsma et al report in their multicenter retrospective observational study on the dose of infliximab prescribed to young (< 10 years) versus older children (> 10 years) with IBD and its association with therapeutic drug levels, treatment response, and the development of antibodies to infliximab [5].…”

mentioning

confidence: 99%

“…Successful induction (with normalization of inflammatory markers as a proxy measure for intestinal mucosal healing) is necessary before embarking on maintenance therapy. These studies challenge us to revisit induction dosing strategies based on the re-interpretation of adult studies for pediatric care [4,5]. A key figure to highlight in this context is that rates of steroid-free remission in adult trials are typically 20% lower than reported rates of clinical remission [6].…”

mentioning

confidence: 99%

“…The use of steroids varies greatly between centers and countries and is often more representative of local expertise and bias than based on evidence [1,7,8]. The common theme of these retrospective studies by Scarpato et al [4] and Jongsma et al [5] being how much "treatment exposure" matters: equally for the positive outcomes of mucosal healing and clinical remission as for the adverse effects of steroid-dependence, loss of response, and primary non-response.…”

mentioning

confidence: 99%

“…Consistent with previous literature, normalization of calprotectin is achieved in a minority of patients using EEN or steroids: the composite outcome of normal Pediatric Crohn's Disease Activity Index (PCDAI) and calprotectin < 100 was achieved in only a small subgroup for both treatments (14% vs 5%). This cohort was recruited before the previous 2014 European pediatric IBD guidelines were published, and these children were therefore not routinely started during induction treatment on an immunomodulator for maintenance [4,13].…”

mentioning

confidence: 99%

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