title: Use of exclusive enteral nutrition is just as effective as corticosteroids in newly diagnosed pediatric Crohn's disease.
abstract: BACKGROUND
  The efficacy of exclusive enteral nutrition (EEN) in induction of remission in pediatric Crohn's disease (CD) is reported to be equivalent to that of corticosteroids (CS).
  
  
  OBJECTIVE
  Our objective was to compare the efficacy of EEN and CS in inducing remission in pediatric onset CD and the effects of the treatment on nutritional status and bone mineral density (BMD).
  
  
  METHODS
  Medical charts were retrospectively studied for patients diagnosed with CD between 2000 and 2010 at the Stollery children's hospital in Edmonton, Alberta. Anthropometric and dual-energy X-ray absorptiometry (DXA) data were collected to assess effects of therapy; clinical remission, relapse, and severity were defined on the basis of the pediatric Crohn's disease activity index.
  
  
  RESULTS
  To induce remission at first presentation, 36 patients (mean age 12.9 years) received EEN and 69 (mean age 11.2 years) received CS. Remission (88.9% in the EEN group versus 91.3% in the CS group (p=0.73) at 3 months) and relapse (40.6 vs. 28.6%, respectively (p=0.12) over 12 months) were similar in both treatment groups. Thirty-four patients had paired DXA scans at the time of diagnosis and one year later: 16 given EEN and 18 given CS. Change in BMD spine z-scores based on bone age adjusted for height and chronological age was greater for EEN patients but not statistically significant (Δz-score 0.30 vs. 0.03, p=0.28).
  
  
  CONCLUSIONS
  EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, T6G 2J3, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Soo
authors.forename: Bushra A
authors.initials: BA
authors.lastname: Malik
authors.forename: Justine M
authors.initials: JM
authors.lastname: Turner
authors.forename: Rabin
authors.initials: R
authors.lastname: Persad
authors.forename: Eytan
authors.initials: E
authors.lastname: Wine
authors.forename: Kerry
authors.initials: K
authors.lastname: Siminoski
authors.forename: Hien Q
authors.initials: HQ
authors.lastname: Huynh
mesh_terms: D000293:Adolescent; D015519:Bone Density; D001846:Bone Development / Q000187:drug effects*; D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids
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