title: Exclusive enteral feeding as primary therapy for Crohn's disease in Australian children and adolescents: a feasible and effective approach.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology, Sydney Children's Hospital and School of Women's and Children's Health, University of New South Wales, Sydney, Australia. andrew.day@unsw.edu.au
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Day
authors.forename: Kylie E
authors.initials: KE
authors.lastname: Whitten
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Lemberg
authors.forename: Cathy
authors.initials: C
authors.lastname: Clarkson
authors.forename: Maribel
authors.initials: M
authors.lastname: Vitug-Sales
authors.forename: Reuben
authors.initials: R
authors.lastname: Jackson
authors.forename: Tim D
authors.initials: TD
authors.lastname: Bohane
mesh_terms: D000293:Adolescent; D001315:Australia; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome