Improvement in quality of life of children with acute Crohn's disease does not parallel mucosal healing after treatment with exclusive enteral nutrition.
BACKGROUND
Crohn's disease is a chronic debilitating disorder affecting a child's physical and emotional well-being. Recent emphasis on 'quality of life' (QOL) has led to re-evaluation of available medical treatments.


OBJECTIVE
To assess prospectively change in QOL, clinical disease activity and intestinal mucosal inflammation in active paediatric Crohn's disease after treatment with exclusive enteral nutrition. In addition, we evaluated whether change in QOL could predict changes in paediatric Crohn's disease activity index (PCDAI) and mucosal inflammation (endoscopic and histologic).


METHODS
The IMPACT II questionnaire was used prospectively and longitudinally in 26 consecutively recruited children [16 males (67%), median 14 years, s.d. = 1.7 years] with active Crohn's disease (PCDAI > 20). They were treated with a new polymeric enteral feed (ACD004, Nestle) for a period of 8 weeks. All had PCDAI, QOL and endoscopic assessment at the time of diagnosis and after 8 weeks of treatment.


RESULTS
Twenty-three of 26 children achieved a clinical remission at 8 weeks, with improvement in the QOL scores (P < 0.05). The change in QOL score after treatment was predictive of achieving a clinical remission, but not of histological improvement.


CONCLUSIONS
Although children may find dietary restrictions difficult, this study confirms a clear improvement in QOL after treatment with exclusive enteral nutrition. However, improvement in QOL scores is not reflected by improvement in mucosal inflammation. Whilst improving QOL remains a core principal in patient management, the long-term consequences of ongoing mucosal inflammation must be better understood before relying only on short-term QOL measures to dictate treatment choices.
Afzal
N A
NA
Centre for Paediatric Gastroenterology, Royal Free Hospital, London, UK. afzaletal@yahoo.co.uk
Van Der Zaag-Loonen
H J
HJ
Arnaud-Battandier
F
F
Davies
S
S
Murch
S
S
Derkx
B
B
Heuschkel
R
R
Fell
J M
JM
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003424:Crohn Disease / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D016896:Treatment Outcome