title: Effect of exclusive enteral nutrition on gut microflora function in children with Crohn's disease.
abstract: OBJECTIVE
  Exclusive enteral nutrition (EEN) is a first-line treatment in children with active Crohn's disease (CD) but is seldom used in adults with active disease. The mode of action of EEN in suppressing mucosal inflammation is not fully understood, but modulation of intestinal microflora activity is one possible explanation. The aim of this study was to investigate the effect of 6-week EEN in children with active CD, with special reference to intestinal microflora function.
  
  
  METHODS
  Fecal samples from 18 children (11 boys, 7 girls; median age 13.5 years) with active CD (13 children with small bowel/colonic and 5 with perianal disease) were analyzed for short chain fatty acid (SCFA) pattern as marker of gut microflora function. The children were studied before and after EEN treatment. Results from 12 healthy teenagers were used for comparison.
  
  
  RESULTS
  Eleven (79%) of the children with small bowel/colonic CD responded clinically positively to EEN treatment showing decreased levels of pro-inflammatory acetic acid as well as increased concentrations of anti-inflammatory butyric acids and also of valeric acids, similar to the levels in healthy age-matched children. In children with active perianal CD, however, EEN had no positive effect on clinical status or inflammatory parameters.
  
  
  CONCLUSIONS
  The authors present new data supporting the hypothesis that the well-documented anti-inflammatory effect of EEN in children with active small bowel/colonic CD is brought about by modulation of gut microflora activity, resulting in an anti-inflammatory SCFA pattern. By contrast, none of the children with perianal disease showed clinical or biochemical improvement after EEN treatment.
authors.affiliation: Department of Microbiology, Karolinska Institute, Tumor and Cell Biology, Stockholm, Sweden. bo.tjellstrom@gmail.com
authors.forename: Bo
authors.initials: B
authors.lastname: Tjellström
authors.forename: Lotta
authors.initials: L
authors.lastname: Högberg
authors.forename: Lars
authors.initials: L
authors.lastname: Stenhammar
authors.forename: Karl-Eric
authors.initials: KE
authors.lastname: Magnusson
authors.forename: Tore
authors.initials: T
authors.lastname: Midtvedt
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Norin
authors.forename: Tommy
authors.initials: T
authors.lastname: Sundqvist
mesh_terms: D019342:Acetic Acid / Q000032:analysis; D000293:Adolescent; D001004:Anus Diseases / Q000628:therapy; D020148:Butyric Acid / Q000032:analysis; D016022:Case-Control Studies; D002648:Child; D003092:Colitis / Q000628:therapy; D003424:Crohn Disease / Q000628:therapy*; D004750:Enteral Nutrition; D005232:Fatty Acids, Volatile / Q000032:analysis; D005243:Feces / Q000737:chemistry; D005260:Female; D005526:Food, Formulated; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D007079:Ileitis / Q000628:therapy; D008297:Male; D054892:Metagenome; D010421:Pentanoic Acids / Q000032:analysis; D011422:Propionates / Q000032:analysis; D018709:Statistics, Nonparametric
chemical_list: D005232:Fatty Acids, Volatile; D010421:Pentanoic Acids; D011422:Propionates; D020148:Butyric Acid; C038780:n-pentanoic acid; C029658:propionic acid; D019342:Acetic Acid