title: Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial.
abstract: OBJECTIVE
  Nutritional therapy has been reported to have an almost equivalent efficacy of corticosteroids in achieving clinical remission in active Crohn's disease (CD). However, the effects of both treatments on intestinal mucosal inflammation rarely are reported. In a randomized controlled trial in children with active CD we compared the efficacy of nutritional therapy alone or corticosteroids on clinical variables and intestinal mucosal healing.
  
  
  METHODS
  In a prospective, 10-week open-label trial, children with active, naive CD were randomized to orally polymeric formula alone or oral corticosteroids. The clinical activity index and nutritional and activity serum variables were evaluated at week 0 and then every 2 weeks; intestinal mucosal inflammation was assessed through endoscopy and histology at weeks 0 and 10. Primary efficacy outcomes were clinical remission and mucosal healing.
  
  
  RESULTS
  Of the 37 children randomized, 19 received polymeric formula and 18 received corticosteroids. At week 10, on an intention-to-treat basis, the proportion of patients achieving clinical remission was comparable between the 2 groups (polymeric formula: 15/19 [79%; 95% confidence interval (CI), 56%-92%]; corticosteroid group: 12/18 [67%; 95% CI, 44%-84%]; P = .4; not significant). On the contrary, the proportion of children showing mucosa healing was significantly higher in the polymeric (14/19; 74%; 95% CI, 51%-89%) than the corticosteroid group (6/18 [33%; 95% CI, 16%-57%]; P < .05). At week 10 both endoscopic and histologic scores significantly decreased only in the polymeric group (P < .001).
  
  
  CONCLUSIONS
  In children with active and recently diagnosed CD, a short course of polymeric diet is more effective than corticosteroids in inducing healing of gut inflammatory lesions.
authors: Division of Pediatric Gastroenterology, Department of Pediatrics, University of Rome "La Sapienza," Rome, Italy.
authors: Osvaldo
authors: O
authors: Borrelli
authors: Letizia
authors: L
authors: Cordischi
authors: Manuela
authors: M
authors: Cirulli
authors: Massimiliano
authors: M
authors: Paganelli
authors: Valeria
authors: V
authors: Labalestra
authors: Stefania
authors: S
authors: Uccini
authors: Paolo M
authors: PM
authors: Russo
authors: Salvatore
authors: S
authors: Cucchiara