title: Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease.
abstract: OBJECTIVE
  Exclusive enteral nutrition (EEN) induces clinical and mucosal healing (MH) in Crohn's disease (CD), with MH the best determinant of future outcome. We investigated efficacy of EEN for inducing early clinical, biochemical, mucosal and transmural remission of CD and related early endoscopic response to outcomes at 1 year.
  
  
  METHODS
  In a prospective, open label study 34 children (mean 13.1 years; 21 males) with new diagnosis CD were offered EEN, 26 completed a minimum 6 weeks EEN and underwent paired clinical, biochemical and endoscopic assessment at start and completion using PCDAI, BMI, CRP and Simple Endoscopic Score for CD (SES-CD). A subset, 16/26, had paired MR enterography scored. Early good endoscopic response (complete MH, or near complete, SES-CD 0-3) was related to outcome at 1 year.
  
  
  RESULTS
  EEN improved mean PCDAI (37.88-7.01, p < 0.001; BMI Z scores (-1.54 to -0.54, p < 0.01); weight Z score (-0.79 to -0.08, p < 0.03); CRP (44.86-5.5, p < 0.001); endoscopy (SES-CD 14.28-3.88, p < 0.001) and MRE (5.14-2.79, p = 0.01). Of 26 children, 22 (84 %) achieved clinical remission; 20 (76 %) biochemical remission. Fifteen (58 %) had early good endoscopic response (11 complete, 4 near complete MH) and 3/14 (21 %) had complete transmural remission of ileal CD (MRE-CD: 0-1). Early good endoscopic response was associated with reduced endoscopic confirmed relapse (53 vs. 100 %, p = 0.02), anti-TNF use (33 vs. 88 %, p = 0.01) and hospitalisation (40 vs. 88 %) at 1 year.
  
  
  CONCLUSIONS
  EEN is effective for inducing early clinical, biochemical, mucosal and transmural remission. Early endoscopic remission improves outcomes at 1 year.
authors: Queensland Children Medical Research Institute, Brisbane, QLD, Australia, z.grover@uq.edu.au.
authors: Zubin
authors: Z
authors: Grover
authors: Richard
authors: R
authors: Muir
authors: Peter
authors: P
authors: Lewindon
mesh_terms: D000293:Adolescent; D001466:Barium Sulfate; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003424:Crohn Disease / Q000097:blood / Q000473:pathology* / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010641:Phenotype; D011446:Prospective Studies; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014945:Wound Healing
chemical_list: D003287:Contrast Media; D014409:Tumor Necrosis Factor-alpha; D001466:Barium Sulfate; D002097:C-Reactive Protein
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