The SES-CD Could Be a Predictor of Short- and Long-Term Mucosal Healing After Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients

Abstract

AimsTo explore the predictors of mucosal healing (MH) for short- and long-term after exclusive enteral nutrition (EEN) in pediatric Crohn’s disease (CD) patients.MethodsA retrospective analysis was performed for newly diagnosed active CD patients admitted to our center from January 2017 to 30 December 2020, who were treated with EEN for induction therapy with a minimum of 12 months of follow-up post-EEN. According to the simple endoscopic score for CD (SES-CD), at 1-year post-EEN, 17 patients with an SES-CD < 3 were classified into the sustained MH group (sMH), and 33 patients with an SES-CD ≥ 3 were classified into the sustained non-MH group (sNMH). Statistical methods were used to compare the differences between the two groups and explore the predictors of MH at the end of EEN and 1-year post-EEN.ResultsThe SES-CD in the sMH group was lower than that in the sNMH group both at baseline and the end of EEN [sMH vs. sNMH: 8.7 ± 1.2 vs. 16.2 ± 1.0, respectively, p < 0.001 at baseline; 1.0 (3.5) vs. 4.0 (2.0), respectively, p < 0.01 at the end of EEN]. The weighted Pediatric Crohn’s Disease Activity Index and erythrocyte sedimentation rate in the sMH group were lower than those in the sNMH group at baseline (both p < 0.05), but showed no difference at the end of EEN. From baseline to 1-year post-EEN, compared with patients in the sNMH group, there were more patients classified with L1 in the sMH group at each time point (all p < 0.001) and fewer patients classified with L3 in the sMH group at baseline and 1-year post-EEN. After EEN, fewer patients received infliximab and had a longer exposure time to infliximab in the sMH group than in the sNMH group. Only the SES-CD at baseline was negatively associated with MH at the end of EEN (OR = 1.40 95% CI = 1.12–1.67, p = 0.00) and 1-year post-EEN (OR = 1.33, 95% CI = 1.12–1.58, p = 0.001), and the cut off value was 11.5.ConclusionThe SES-CD could predict both short- and long-term MH for EEN. Patients with an SES-CD < 11.5 had a high probability of reaching MH by EEN-inducing therapy and maintaining sustained MH at 1-year post-EEN. Patients with an SES-CD greater than 11.5 at baseline should be treated more aggressively with biologics.

Efficacy of exclusive enteral nutrition on the mucosal healing of different gastrointestinal segments in children with Crohn's disease

“…Similar results were observed in patients who received anti-TNF-α therapy. 22 These findings indicate that early MH is important for patients with CD, 4,5,29 especially those with moderate to severe lesions at baseline. Both EEN and anti-TNF-α therapy reportedly induce early MH, 9,30,31 but few studies have systematically compared their differences with regard to early MH.…”

“…Notably, lesions in the terminal ileum and right colon were worse than those in other ileocolonic segments at baseline, and these results were consistent with our previous study. 5 A study indicated that ileal involvement might predict better clinical outcomes for EEN therapy, 12 and isolated colonic CD was associated with a poorer response to EEN. 13 These results are not consistent with ours, possibly because of the different primary outcomes, as clinical remission was the main outcome in these studies.…”

“…Mucosal healing (MH) is the ultimate goal for CD 3 . Early MH is associated with improved patient outcomes and a reduced rate of complication 4–6 . Exclusive enteral nutrition (EEN) is recommended as the first‐line therapy to induce remission in children with CD 3,7 .…”

An update on dietary therapies in paediatric Crohn's disease

“…Predictors of response to treatment are important to inform clinical decisions on patient management. Milder endoscopic disease, at baseline, was the sole predictor of mucosal healing both at EEN completion and after one year of follow-up in a recent retrospective study in 50 children in China [13]. Likewise, in a retrospective study among 366 children with CD in Italy, age >15 years and a Paediatric Crohn's Disease Activity Index >50 were associated with lower response rates [14].…”

Precision nutrition in pediatric IBD: A position paper from the ESPGHAN special interest group for basic science and translational research, the IBD Porto group, and allied health professionals

“…The authors recommended that children with CD with a simple endoscopic score for CD cut-off value > 11.5 should be treated with biologics. 37 T A B L E 2 Evidence tables of studies which explored aspects of treatment precision/stratification in patients with Crohn's disease on exclusive enteral nutrition.…”