Exclusive enteral feeding as primary therapy for Crohn's disease in Australian children and adolescents: A feasible and effective approach

被引:135
作者
Day, Andrew S.
Whitten, Kylie E.
Lemberg, Daniel A.
Clarkson, Cathy
Vitug-Sales, Maribel
Jackson, Reuben
Bohane, Tim D.
机构
[1] Sydney Childrens Hosp, Dept Gastroenterol, Randwick, NSW 2031, Australia
[2] Sydney Childrens Hosp, Dept Dietet, Randwick, NSW 2031, Australia
[3] Univ New S Wales, Sch Womens & Childrens Hlth, Sydney, NSW, Australia
关键词
children; Crohn's disease; enteral feeding; inflammatory bowel disease; nutrition;
D O I
10.1111/j.1440-1746.2006.04294.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Exclusive enteral feeding has been shown to be as efficacious as corticosteroids in inducing remission in children with Crohn's disease (CD), with additional nutritional benefits. The use of polymeric formulae provides superior palatability and acceptance over elemental feeds, but polymeric formulae have not been universally adopted. The present retrospective analysis of enteral feeding in children with Crohn's disease aims to demonstrate the short-term benefits of enteral feeding in children upon disease activity and nutrition parameters. The case records of children with CD managed with exclusive enteral nutrition (EEN) by a multidisciplinary team over a 2-year period were reviewed. Data relating to therapy, background disease details, and outcome were collated. Primary outcome measures established were weight change and disease activity (Pediatric Crohn's Disease Activity Index: PCDAI). Twenty-seven children received EEN with polymeric formulae. Fifteen children had newly diagnosed CD and 12 had known long-standing CD. Twenty-four children completed the prescribed period of EEN. Twelve of 15 (80%) newly diagnosed CD and seven of 12 (58%) with long-standing disease entered remission. Children with newly diagnosed CD responding to EEN took all feeds orally and gained an average of 4.7 +/- 3.5 kg with mean PCDAI decreasing from 37.1 +/- 10.8 to 6.7 +/- 5.1 after 8 weeks. In addition, four children continued supplementary polymeric formula (without other medical therapies) and all have maintained remission during an average follow-up period of 15.2 months. Exclusive enteral feeds induced remission in 80% of children with newly diagnosed CD (on intention-to-treat basis) when used as sole initial therapy while also improving nutritional status. All newly diagnosed children treated with EEN, who were able to establish feeds, achieved remission. In addition, remission may be prolonged with oral supplementary formula as sole ongoing treatment. Further study of the role(s) of enteral feeds and of longer-term benefits of enteral feeding in children with CD is now required.
引用
收藏
页码:1609 / 1614
页数:6
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