Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Lv, Yao; Lou, Yue; Yang, Gan; Luo, Youyou; Lou, Jingan; Cheng, Qi; Yu, Jindan; Fang, Youhong; Zhao, Hong; Peng, Kui; Chen, Jie

doi:10.1155/2022/3813915

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…However, the exact efficacy of these types of enteral formula on patients with different disease behaviors or locations has not been systematically reported. Similarly to ours, previous studies reported an MH rate of 43%–80.8% with polymeric-based enteral nutrition in pediatric CD [ 15 , 16 , 29 , 30 ]. The MH rate in the present study was 45.5% after an 8-week intervention.…”

Section: Discussionsupporting

confidence: 86%

“…Another study demonstrated a complete MH in 33% of patients who received ≥6 weeks of EEN using the simple endoscopic score for CD without detailing the enteral formula type [ 16 ]. Yao et al [ 15 ] retrospectively reported a MH rate in 73.3% and 80.8% of pediatric patients in the infliximab- and polymeric-based EEN groups, respectively ( P = 0.374). As mentioned above, most pediatric studies reported the MH rate with a polymeric-based formula, while data based on an amino acid enteral formula are limited.…”

Section: Discussionmentioning

confidence: 99%

“…The GROWTH-CD study demonstrated that EEN more effectively induced remission than corticosteroids and had other benefits, including improved growth [ 14 ]. Studies also suggest that the proportion of clinical and endoscopic remission in EEN (88.57% and 68.75%) was similar to those in an anti-TNF-α agent (infliximab, 73.91% and 80.77%) after induction therapy [ 15 ]. Overall, EEN is clinically efficacious and is associated with improved mucosal healing (MH), linear growth, and bone health during induction treatment in pediatric CD [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Amino acid-based enteral nutrition is effective for pediatric Crohn’s disease: a multicenter prospective study

Yang,

Zhang,

Diao

et al. 2023

Gastroenterology Report

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Background Exclusive enteral nutrition (EEN) therapy effectively induces remission in pediatric Crohn’s disease (CD). However, this may depend on the type of enteral formula used. Moreover, data on the efficacy of amino acid-based EEN are limited. Thus, we aimed to prospectively evaluate the efficacy of amino acid-based formulas for EEN in pediatric patients with active CD. Methods Patients with active CD aged between 6 and 17 years were recruited into this prospective study from four hospitals in China between March 2019 and December 2021. Patients received EEN for 8 weeks. Inflammatory and nutrition-associated indices were evaluated at 0, 4, and 8 weeks after treatment. Paired t-tests and Wilcoxon signed-rank tests were used to compare continuous and categorical variables before and after intervention, respectively. Results Twenty-four patients were included in the analysis. After an 8-week intervention period, the CD activity index significantly decreased (26.3 ± 12.2 vs 7.1 ± 8.3, P < 0.001). Most patients (66.7%) achieved complete clinical remission. Among the 22 patients who had ulcers and erosions diagnosed endoscopically at baseline, 10 (45.5%) achieved complete mucosal healing. The degree of thickening of the intestinal wall was significantly reduced after EEN intervention, with a transmural healing rate of 42.9%. Furthermore, the serum inflammatory markers decreased and there was a significant improvement in the nutrition-related indices (P < 0.05). There were no severe adverse effects. Conclusions Amino acid-based EEN is effective and safe for treating pediatric-onset CD. Studies with larger sample sizes and mechanistic and follow-up studies are required to further validate these findings.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Amino acid-based enteral nutrition is effective for pediatric Crohn’s disease: a multicenter prospective study

Yang,

Zhang,

Diao

et al. 2023

Gastroenterology Report

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“…In contrast to the “TISKids” trial, a retrospective study by Lv et al [12] did not show any differences in clinical or endoscopic remission rates induced by EEN compared to infliximab, in children with newly diagnosed, treatment-naïve mild-to-moderate CD. Clinical (EEN: 89% vs. Infliximab: 74%) and endoscopic (EEN: 81% vs. Prednisolone: 73%) remission rates were comparable between the two treatments.…”

Section: Use Of Een In the Era Of Advanced Therapiesmentioning

confidence: 81%

An update on dietary therapies in paediatric Crohn's disease

Gkikas,

Svolos,

White

et al. 2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review This article provides a literature update on original articles published in the past 18 months (May 2022–November 2023) in the dietary management of paediatric Crohn's disease. Recent findings There is more data to support the use of exclusive enteral nutrition in the management of active Crohn's disease in children. Several food-based dietary therapies have been proposed for the management of Crohn's disease. There is an interest in precision nutritional therapy in Crohn's disease, but current data are scarce. Summary Exclusive enteral nutrition is an effective treatment for paediatric Crohn's disease. Predictors of response to exclusive enteral nutrition include mild disease phenotype and ileal disease involvement, although data remain inconclusive. Adherence to exclusive enteral nutrition is cornerstone to its efficacy. Treatment with exclusive enteral nutrition modifies the gut microbiome, modulates bile acid metabolism and has significant effects on host immune responses. More studies are expected in which drugs need to be combined with dietary therapies and microbial therapeutics. The efficacy of Crohn's disease exclusion diet coupled with partial enteral nutrition is supported by independent studies, but tolerance remains an issue, particularly for long-term disease management. More research is anticipated in precision nutritional therapy in paediatric Crohn's disease, but currently no recommendations can be made.

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“…EEN is the rst-line induction therapy for children with mild to moderate CD [5], providing complete daily nutritional requirements with a complete liquid diet consisting of polymeric or elemental formula (either orally or via a feeding tube) and avoidance of solid foods for 6 to 8 weeks [6]. The rate of clinical and endoscopic remission after EEN induction therapy is approximately 60-80% [7]. EEN has several advantages, such as the ability to control in ammatory changes; improve mucosal healing, linear growth, and bone health; and has no side effects compared with other induction treatments [8].…”

Section: Introductionmentioning

confidence: 99%

Early predictors of induction of remission with exclusive enteral nutrition in pediatric Crohn's disease

Hu,

Lv,

Lou

et al. 2024

Preprint

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Background Exclusive enteral nutrition (EEN) is recommended as the first line therapy for mild to moderate pediatric Crohn's disease (CD) with inducing clinical remission and promoting mucosal healing. However, early factors that could predict the efficacy of EEN in inducing remission of CD is lack. Methods A total of 56 patients in the derivation cohort and 19 patients in the validation cohort were included in this study. Baseline clinical covariates were compared between the clinical remission group and the no clinical remission group and between the mucosal healing group and the no mucosal healing group. More than 100 laboratory covariates before EEN were analyzed with the Pediatric Crohn’s Disease Activity Index(PCDAI) and the Crohn’s Disease Endoscopic Index of Severity (CDEIS)at the end of the 8-week EEN. Predictive models were developed by forward stepwise (binary likelihood) logistic regression, and the probabilities of clinical remission and mucosal healing were calculated for selected baseline levels of covariates. Results The clinical remission diagnostic model performed well inboth the training cohort (AUC 0.93; p<0.05) and the validation cohort (AUC 0.72; p=0.19). Indirect bilirubin (IBIL)>4.95 μmol/L, CD3>76.78% and iron>9.025 mmol/L at baseline were associated with a reduced clinical remission rate. The mucosal healing diagnostic model also presented the optimal discrimination in both the derivation cohort (AUC 0.87; p<0.05) and the validation cohort (AUC 0.83; p=0.07). Factors determining a lower mucosal healing rate were human IL-10>4.35 μmol/L and RDW>14.55%. Conclusion IBIL, CD3 and iron are reliable predictors of the induction of clinical remission with EEN. Human IL-10 and RDW are early predictors of the induction of mucosal healing with EEN.

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Outcomes of Pediatric Patients with Crohn’s Disease Received Infliximab or Exclusive Enteral Nutrition during Induction Remission

Cited by 5 publications

References 28 publications

Amino acid-based enteral nutrition is effective for pediatric Crohn’s disease: a multicenter prospective study

Amino acid-based enteral nutrition is effective for pediatric Crohn’s disease: a multicenter prospective study

An update on dietary therapies in paediatric Crohn's disease

Early predictors of induction of remission with exclusive enteral nutrition in pediatric Crohn's disease

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