Use of Exclusive Enteral Nutrition Is Just as Effective as Corticosteroids in Newly Diagnosed Pediatric Crohn’s Disease

Soo, Jason; Malik, Bushra A.; Turner, Justine; Persad, Rabin; Wine, Eytan; Siminoski, Kerry; Huynh, Hien Q.

doi:10.1007/s10620-013-2855-y

Cited by 53 publications

(44 citation statements)

References 43 publications

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“…Several milk-derived therapeutic preparations are already available to clinicians. Among the most notable are TGF-b-supplemented formula, which has become an important treatment option for some types of pediatric inflammatory bowel disease, 119 and hyperimmune bovine colostrum preparations used in the prevention of enterotoxic E. coli infection. 13 Many human milk components have shown promise in preclinical studies and are undergoing active clinical evaluation.…”

Section: Resultsmentioning

confidence: 99%

“…118 In a recent study, TGF-b supplementation and traditional corticosteroid treatment were equally effective in inducing disease remission, although the TGF-b formula was associated with an improved nutrition profile and fewer side effects. 119 This comprehensive TGF-b-containing enteral nutrition formulation is now available by prescription in the United States as a primary treatment for pediatric Crohn's disease or as complementary or alternative treatment of adult Crohn's disease (Modulen IBD, Nestlé Nutrition, Florham Park, New Jersey, USA). Although the mechanism of action in human patients has not been precisely defined, exclusive consumption of TGF-b-supplemented formula may be associated with alterations in the intestinal microbiota.…”

Section: Immunomodulatory Properties Of Transforming Growth Factor Bmentioning

confidence: 99%

“…120 The supplementation of infant formula with TGF-b is an example of the potential use of bioactive milk components in clinical practice (Table 2). [36][37][38]104,[116][117][118][119][121][122][123][124][125][126][127][128][129][130] …”

Section: Immunomodulatory Properties Of Transforming Growth Factor Bmentioning

confidence: 99%

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Clinical applications of bioactive milk components

Hill

Newburg

2015

Nutrition Reviews

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Milk represents a unique resource for translational medicine: It contains a rich pool of biologically active molecules with demonstrated clinical benefits. The ongoing characterization of the mechanistic process through which milk components promote development and immunity has revealed numerous milk-derived compounds with potential applications as clinical therapies in infectious and inflammatory disease, cancer, and other conditions. Lactoferrin is an effective antimicrobial and antiviral agent in high-risk patient populations and a potentially potent adjuvant to chemotherapy in lung cancer. Enteric nutrition formulas supplemented with transforming growth factor b, a milk cytokine, have been shown to promote remission in pediatric Crohn's disease. A number of milk glycans, including human milk oligosaccharides, show promise in preclinical studies as antimicrobial and antiinflammatory agents. While active preclinical investigations of human milk may soon result in large-scale production of human milk molecules, bovine milk components in many instances represent a practical source of bioactive milk compounds for use in clinical trials. This review summarizes current efforts to translate the compounds derived from human and bovine milk into effective clinical therapies. These efforts suggest a common pathway for the translation of milk-derived compounds into clinical applications.

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Section: Resultsmentioning

confidence: 99%

Section: Immunomodulatory Properties Of Transforming Growth Factor Bmentioning

confidence: 99%

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Clinical applications of bioactive milk components

Hill

Newburg

2015

Nutrition Reviews

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“…In addition to improving nutrition of children with CD, use of EN has been found to positively impact bone health, as evidenced by lower levels of markers of bone resorption, higher markers of bone turnover, increased bone accrual, and improvement in vitamin D levels …”

Section: Outcomes Associated With Enteral Nutritionmentioning

confidence: 99%

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

Shaikhkhalil

Crandall

2018

Nut in Clin Prac

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Enteral nutrition (EN) for the treatment of Crohn's disease (CD) involves administration of a liquid nutrition product, administered orally or through tube feeding, while excluding typical dietary components. It is a safe and effective, but largely underused, therapy in the United States as a treatment for CD. EN is a particularly attractive option for pediatric CD as it avoids side effects of corticosteroids, improves growth, and may have a higher likelihood of achieving mucosal healing than some traditional medications. However, there are multiple real and perceived barriers to its use among providers. A comprehensive approach to addressing these barriers to EN may result in its increased use. This paper reviews the literature on the efficacy of EN, methods of utilization, and potential barriers and solutions to those barriers.

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“…Polymeric formulas have shown similar efficacy in comparison to elemental formulas [79] with inherent advantages including better palatability, reduction of the need for tube feeding and improved adherence [80]. In children, EEN was demonstrated to be as effective as corticosteroids in inducing remission [81][82][83] and was superior in inducing mucosal healing [84,85]. EEN downregulates pro-inflammatory cytokines including TNF-α and IL-6 [86,87], induces prompt reduction in inflammatory markers with a consequent increase in IGF-1 and IGFBP-3 within 14 days of treatment [85,88,89].…”

Section: Exclusive Enteral Nutrition (Een)mentioning

confidence: 99%

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

Shamir¹

2014

J Clin Cell Immunol

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Growth retardation is a common complication of pediatric inflammatory bowel disease (IBD), which may have long term effects on final adult height and carries significant social and psychological implications. Etiology may be multifactorial including undernutrition, metabolic dysregulation, inflammatory impact on hormonal growth axis and the effect of drugs such as glucocorticoids. Control of disease activity and minimizing the need for corticosteroid therapy are necessary measures in order to facilitate normal growth. However, in many cases these strategies are not sufficient. Currently, there is inconsistent evidence regarding the efficacy of available therapeutic agents to induce long-term effect on growth. The new era of biologic therapies which carries a greater potential to achieve mucosal healing, holds promise for better growth even in children with severe growth impairment. It becomes apparent that prompt recognition of growth impairment combined with aggressive tailored therapeutic approach may offer the best chance for catch-up growth. This review will discuss the definition, prevalence and mechanism of growth retardation in children with IBD and highlight the specific benefits of current therapeutic strategies.

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Use of Exclusive Enteral Nutrition Is Just as Effective as Corticosteroids in Newly Diagnosed Pediatric Crohn’s Disease

Abstract: EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.

Cited by 53 publications

References 43 publications

Clinical applications of bioactive milk components

Clinical applications of bioactive milk components

Enteral Nutrition for Pediatric Crohn's Disease: An Underutilized Therapy

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

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