title: The efficacy of exclusive nutritional therapy in paediatric Crohn's disease, comparing fractionated oral vs. continuous enteral feeding.
abstract: BACKGROUND
  Nutritional therapy has an established role as induction therapy in paediatric Crohn's disease. However, compliance is the main difficulty and may be greatly influenced by the administration route.
  
  
  OBJECTIVE
  To analyse the efficiency of exclusive nutrition to induce remission in children with Crohn's disease comparing fractionated oral vs. continuous enteral feeding.
  
  
  METHODS
  The medical records of 106 patients treated by exclusive nutritional therapy [Modulen IBD (R)] by either oral or continuous enteral route were reviewed retrospectively. Comparative analyses of remission rates, changes in anthropometry, Paediatric Crohn's disease Activity Index (PCDAI), laboratory indices and compliance rates were performed.
  
  
  RESULTS
  On exclusive enteral nutrition, at 8 weeks, 34/45 patients achieved remission in the oral group (75% on intention-to-treat analysis) and 52/61 (85%) in the enteral nutrition group (P = 0.157). All patients showed a significant decrease in disease severity assessed by PCDAI (P < 0.0001) and significant improvements in anthropometric measures and inflammatory indices. No difference was observed whether Modulen IBD was administered orally or by continuous enteral feeding, apart from weight gain, which was greater in the enteral group (P = 0.041). In a subgroup of patients, mucosal healing was evidenced on follow-up endoscopies showing a clear correlation to remission. Compliance rates (87% and 90%) were similar. Nevertheless, noncompliant patients had lower mucosal healing and remission rates.
  
  
  CONCLUSIONS
  These retrospective data suggest that the use of fractionated oral nutritional therapy might be as efficacious as continuous enteral administration to induce remission and mucosal healing in children with Crohn's disease. However, appropriate prospective clinical trials are needed to confirm these findings.
authors.affiliation: Pediatric Gastroenterology Unit, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, INSERM, Université Paris Descartes, France.
authors.forename: A
authors.initials: A
authors.lastname: Rubio
authors.forename: B
authors.initials: B
authors.lastname: Pigneur
authors.forename: H
authors.initials: H
authors.lastname: Garnier-Lengliné
authors.forename: C
authors.initials: C
authors.lastname: Talbotec
authors.forename: J
authors.initials: J
authors.lastname: Schmitz
authors.forename: D
authors.initials: D
authors.lastname: Canioni
authors.forename: O
authors.initials: O
authors.lastname: Goulet
authors.forename: F M
authors.initials: FM
authors.lastname: Ruemmele
mesh_terms: D001835:Body Weight; D002648:Child; D003424:Crohn Disease / Q000178:diet therapy* / Q000503:physiopathology / Q000523:psychology; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018529:Nutritional Support; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome