The practice of exclusive enteral nutrition in children with Crohn's disease

Introduction: Exclusive enteral nutrition is the first choice of induction treatment in pediatric luminal Crohn's disease with low risk. Based on the data of the Hungarian Pediatric Inflammatory Bowel Disease Registry, the use of exclusive enteral nutrition has been increased in Hungary. However, according to international surveys, the practical implementation of exclusive enteral nutrition varies among individual centers. Objective: The aim of our study was to assess the practice of exclusive enteral nutrition and the related difficulties in Hungary. Method: The practice of exclusive enteral nutrition was evaluated via an online questionnaire. The questionnaire consisting of 26 questions was sent to 34 pediatric gastroenterologists. Results: The questionnaire was filled in by 21 (62%) pediatric gastroenterologists, all of them answered all the 26 questions. More than half of the respondents (57%) answered that they always start exclusive enteral nutrition as an induction treatment for children with newly diagnosed Crohn's disease. Regarding the method of implementation, the majority of respondents use an inflammatory bowel disease-specific formula (66.7%). Most of the colleagues allow the consumption of water only in addition to formula (61.9%), while others allow hard candies, chewing gums, clear liquids and fruit juice. A quarter of the pediatric gastroenterologists who filled out the questionnaire try the nasogastric tube in the case of oral intolerance. In case of relapse, 50% of them recommend repeatedly exclusive enteral nutrition. Two-thirds of the respondents are supported by a dietitian. Conclusion: In Hungary, exclusive enteral nutrition is applied according to the guidelines in a similar proportion to the international practice.