International survey of enteral nutrition protocols used in children with Crohn's disease

Abstract

OBJECTIVE: Differing protocols have been utilized in published studies evaluating exclusive enteral nutrition (EEN) in the management of active pediatric Crohn's disease. This study aimed to ascertain the protocols currently utilized in different pediatric centers around the world and to highlight their similarities and differences. METHODS: A questionnaire was circulated to individuals at pediatric centers in countries in Europe, North America and Asia–Pacific. Respondents were asked to indicate the number of children treated with EEN at their centers in the previous years and to provide details of their protocol used for administering EEN to these children. RESULTS: Responses were received from 35 separate centers (42% of those asked). The duration of EEN varied from <6 weeks to >12 weeks, but was most commonly 6 to 8 weeks. Although 23 different formulas were utilized across the centers, most (90%) used polymeric formulas. Flavourings were commonly added to formulas but wide variations existed between centers with the prescription of food and fluids permitted during the EEN period. The reintroduction of food after EEN also varied greatly: the most common recommendations were for an initial low‐fiber diet (26%) or the gradual introduction of food quantity as the formula volume decreased (52%). CONCLUSIONS: This questionnaire‐based study has shown the wide variations in EEN protocols used in different areas of the world. The development of consistent protocols may enhance the acceptance, efficacy and wider utilization of this therapy.

Exclusive enteral nutrition and induction of remission of active Crohn’s disease in children

“…Nonetheless, pediatric units are noted to use a range of nutritional products [13]. It is possible that differences in the funding of or access to particular products may dictate the use of these.…”

“…Although EEN is defined in this manner, a number of aspects of EEN protocols are yet to be firmly established and consequently there are substantial variations in the way EEN is delivered [13]. These include the length of therapy, the type of formula, the use of additional dietary elements along with EEN and the methods by which EEN is delivered.…”

“…The standard length of EEN used in various different countries varies between 4 and 12 weeks [13]. Some data suggest that most anti-inflammatory and nutritional benefits have occurred by 4 weeks, and that 8 weeks of therapy are not required [16].…”

“…Despite the concept of exclusivity, many units around the world allow various nutritional components in their EEN protocol [13]. These include the use of boiled lollies, clear fluids such as lemonade and the use of tea or coffee.…”

“…A survey of pediatric units noted that this phase of EEN is variable [13]. One standard approach is to introduce one simple meal every 3-4 days, while slowly reducing the volume of enteral formula.…”