title: Colonic Crohn's disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved.
abstract: Data supporting a response to treatment with exclusive enteral nutrition in pediatric colonic Crohn's disease are few. We examined clinical and biochemical responses of ileal, colonic, and ileocolonic Crohn's disease and assessed the endoscopic and histological colonic mucosal response in the colonic and ileocolonic groups. We prospectively enrolled 65 children (age: 8-17 years) with acute intestinal Crohn's disease (Pediatric Crohn's Disease Activity Index [PCDAI] >20). After ileocolonoscopy, gastroscopy, and a barium meal and follow-through, they were distributed into three groups (ileal, n = 12, ileocolonic, n = 39; and colonic, n = 14). All patients received exclusive polymeric feed as treatment, with a repeat endoscopy at completion of treatment. At enrollment the ileal group had significantly less severe disease (P = 0.05) compared to the colonic and ileocolonic groups. However, the colonic disease group showed the least fall in PCDAI scores at completion of treatment with enteral nutrition (P = 0.03), with the lowest remission rate (50%, vs 82.1% in the ileocolonic and 91.7% in the ileal group [chi2 test, P = 0.021]). Endoscopic and histologic colonic mucosal assessment showed a post-treatment improvement in the ileocolonic (P < or = 0.01) but not in the colonic disease group (P = ns). Children with disease in the colon respond better to enteral nutrition if the ileum is also involved. This may be due to different underlying inflammatory mechanisms. Detailed pretreatment assessment in studies of Crohn's disease according to disease distribution with appropriate individualized tailoring of treatment may be important in this regard.
authors.affiliation: Centre for Pediatric Gastroenterology, Royal Free Hospital, London, UK. afzaletal@yahoo.co.uk
authors.forename: Nadeem A
authors.initials: NA
authors.lastname: Afzal
authors.forename: Sue
authors.initials: S
authors.lastname: Davies
authors.forename: Morine
authors.initials: M
authors.lastname: Paintin
authors.forename: Franck
authors.initials: F
authors.lastname: Arnaud-Battandier
authors.forename: John A
authors.initials: JA
authors.lastname: Walker-Smith
authors.forename: Simon
authors.initials: S
authors.lastname: Murch
authors.forename: Robert
authors.initials: R
authors.lastname: Heuschkel
authors.forename: John
authors.initials: J
authors.lastname: Fell
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D003092:Colitis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007079:Ileitis / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome