Inducing remission in paediatric Crohn’s disease using nutritional therapies – A systematic review

Abstract

Background Exclusive enteral nutrition (EEN) is known to be a safe and effective treatment option for managing active Crohn’s disease (CD) in children, although no uniform protocol exists. The aim of this systematic review was to evaluate and compare the clinical effectiveness of aspects of EEN protocols to ascertain whether an optimum regimen can be identified. Methods A systematic search of the Cochrane Library, PubMed, MEDLINE, EMBASE, CINAHL and AMED was conducted for studies published between 1998 and 2018 that examined paediatric patients being treated with an enteral nutrition protocol to induce remission. Studies that included patients receiving concurrent medication for active disease were excluded. Quality assessment was performed using separate tools for randomised controlled trials, cohort studies and for studies without a control group. Results Sixteen studies met the inclusion criteria. Of these, six found insufficient evidence to support use of a specific formula. One study examined the route of EEN, finding no difference between oral or nasogastric tube administration with respect to inducing remission. Three examined the use of partial enteral nutrition to induce remission, although conflicting results were seen. No studies explored the effect of length of treatment or energy prescription on remission rates Conclusions An optimum enteral nutrition protocol for inducing remission cannot be identified. Further focused research is required by well designed, adequately powered prospective clinical trials to examine aspects of enteral feeding protocols that remain uncertain, including the use of partial enteral nutrition as a potential alternative to EEN.

Dietary patterns, beliefs and behaviours among individuals with inflammatory bowel disease: a cross‐sectional study

“…Because IBD affects the gastrointestinal system, patients often question how modifying their diet may influence IBD symptoms (4)(5)(6) . Some studies have shown the benefits of diet modification, through altering food intake, on symptom reduction and quality of life in IBD patients (5,(7)(8)(9) . Indeed, children with Crohn's disease on 8 weeks of exclusive enteral nutrition, a nutritionally complete liquid diet, demonstrated a greater likelihood of remission compared to children who do not use exclusive enteral nutrition (10) .…”

Meta‐analysis: efficacy of exclusive enteral nutrition as induction therapy on disease activity index, inflammation and growth factors in paediatric Crohn’s disease

“…Current literature demonstrates that EEN improves growth factors and disease progression in patients with CD 17 . There is no specific analysis in this regard in previous studies, so it is necessary to use meta‐analysis studies to determine the effectiveness.…”

“…15,16 Current literature demonstrates that EEN improves growth factors and disease progression in patients with CD. 17 There is no specific analysis in this regard in previous studies, so it is necessary to use meta-analysis studies to determine the effectiveness. Therefore, this study is the first to demonstrate conclusive evidence clarifying EEN's biomedical function to better inform healthcare staff on its therapeutic effectiveness.…”