Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with Crohn's disease.
BACKGROUND
Exclusive enteral nutrition (EEN) is an effective first line treatment for active paediatric Crohn's disease (CD).


OBJECTIVE
To examine the effect of EEN on short- and long-term clinical outcome together with anthropometric measurements.


METHODS
Retrospective case-note review in newly diagnosed CD (<16 years) who completed 8 weeks of EEN. Demographics, anthropometry, disease characteristics and inflammatory markers were collected at EEN initiation and at 1, 2, 6, 12 & 24 months post treatment initiation. EEN response was determined by a patient global assessment.


RESULTS
One hundred and nine patients were included (Males 68; Median age: 11.2 years). After 8 weeks EEN, 65 were in remission, 32 improved and 12 had no improvement. By 4 weeks, mean weight/BMI z-score (s.d.) increased (P < 0.02) and between 4 and 8 weeks (P < 0.05). Baseline inflammatory markers all improved significantly by week 4 (albumin, CRP and platelets; all P < 0.01) and ESR (P < 0.00001). 63/109(58%) relapsed during follow-up. 44/63(70%) patients completed a second course of EEN with similar response rate, but lower weight gain (3.3 vs. 5.1 kg, P < 0.05). Height z-score did not change significantly over the 24 months. Introduction of azathioprine within 6 months of diagnosis did not improve height outcomes at 24 months.


CONCLUSIONS
Weight and BMI z-score improved with EEN and changes are sustained to 2 years, but height z-score did not. Seventy per cent of patients who relapsed during 2-year follow-up managed a 2nd course of EEN. The optimal therapeutic strategies for length of EEN course and to improve linear growth are awaited.
Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK.
F L
FL
Cameron
K
K
Gerasimidis
A
A
Papangelou
D
D
Missiou
V
V
Garrick
T
T
Cardigan
E
E
Buchanan
A R
AR
Barclay
P
P
McGrogan
R K
RK
Russell
D000293:Adolescent; D015415:Biomarkers; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D003424:Crohn Disease / Q000150:complications / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D015415:Biomarkers