title: Standard versus rapid food reintroduction after exclusive enteral nutritional therapy in paediatric Crohn's disease.
abstract: BACKGROUND
  In paediatric Crohn's disease (PCD), 6-8 weeks of exclusive enteral nutrition (EEN) is effective in 60-80% cases. EEN is followed by gradual food reintroduction over variable (1-5 weeks) periods. Currently, there is no recommended duration or method for food reintroduction. The rationale for slow reintroduction is unclear and may be because of concerns about food intolerance or to maintain longer remission.
  
  
  OBJECTIVE
  The aims of this study were as follows: to compare relapse rates following standard and rapid reintroduction of food after EEN in PCD and to determine the duration of maintained remission in two groups of PCD patients.
  
  
  METHODS
  Two groups with PCD were compared: group A received standard food reintroduction over 5 weeks and group B received rapid reintroduction over 3 days. Data were collected over two consecutive time periods: group A (2005-2009) and group B (2009-2011). Only patients with a new diagnosis of PCD were included. Those with strictures and those on steroids or biologicals during EEN were excluded. The minimum duration of follow-up was 1 year.
  
  
  RESULTS
  Group A included 20 patients and group B included 19 patients. In these groups, EEN led to clinical remission in 80% of the patients in group A and in 76% of the patients in group B. At 6 months, one-third of the patients from each group had developed relapse and a year after EEN, 50% of the patients in group A and 47% of the patients in group B developed relapse. Time to first relapse was 188 days (group A) and 136 days (group B). None of these results were statistically significant.
  
  
  CONCLUSIONS
  In PCD, rapid food reintroduction following 6-week EEN is safe and equally effective as longer food reintroduction. We propose that a rapid food reintroduction schedule be recommended as the most tolerable approach for food reintroduction. Relapse rate and duration of remission are uninfluenced by the type of food reintroduction.
authors.affiliation: aPaediatric Gastroenterology Dietitian, Child Health bCentre for Paediatric Gastroenterology, Royal Free Hospital, London, UK.
authors.forename: Abi
authors.initials: A
authors.lastname: Faiman
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mutalib
authors.forename: Alexander
authors.initials: A
authors.lastname: Moylan
authors.forename: Natalie
authors.initials: N
authors.lastname: Morgan
authors.forename: Daniel
authors.initials: D
authors.lastname: Crespi
authors.forename: Mark
authors.initials: M
authors.lastname: Furman
authors.forename: Ajmal
authors.initials: A
authors.lastname: Kader
mesh_terms: D002648:Child; D003424:Crohn Disease / Q000628:therapy*; D004032:Diet; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005502:Food / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome