title: Early Mucosal Healing with Exclusive Enteral Nutrition is Associated with Improved Outcomes in Newly Diagnosed Children with Luminal Crohn's disease.
abstract: BACKGROUND
  Exclusive Enteral Nutrition (EEN) induction in children with luminal Crohn's disease (CD) gives early mucosal healing (MH), but the long-term benefits of EEN-induced MH are just emerging.
  
  
  OBJECTIVE
  We prospectively followed an Australian cohort of newly diagnosed children with predominantly luminal CD who completed at least six weeks EEN and with paired clinical Pediatric Crohn's Disease Activity Index (PCDAI), biochemical (C-reactive protein; CRP) and endoscopic assessment at diagnosis and post EEN. All commenced immunomodulators (IMs) early (<3 months from diagnosis) and had a minimum of 1 year follow-up. Complete MH was a simple endoscopic score for Crohn's disease (SES-CD) of 0, and SES-CD≥1 was ascribed to active endoscopic disease (aED) and further divided into near complete MH (SES 1-3), mild active disease (SES-CD 4-10) and moderate to severe disease (SES-CD>10). The primary outcome was long-term supervised sustained remission (SR) on IMs alone without need for corticosteroids, infliximab (IFX) or surgery.
  
  
  RESULTS
  A total of 54 eligible children (33 males) completing EEN induction were analysed. The median duration between pre and post EEN assessments was 60.5 days [interquartile range (IQR), 56-69.5]. Post EEN: clinical remission (PCDAI < 10) was observed in 45/54 (83%), and biochemical remission (PCDAI < 10 and CRP < 5 mg/dl) was observed in 39/54 (72%). Complete MH was observed in 18/54 (33%), near complete in 10/54(19%). SR was superior in those with complete MH vs. aED; 13/18, (72%) vs. 10/36 (28%), p = 0.003 at 1 year, 8/16, (50%) vs. 3/24, (8%), p = 0.008 at 2 years and (8/16, (50%) vs. 1/19, (6%), p = 0.005) at 3 years. Near-complete MH did not lead to superior SR.
  
  
  CONCLUSIONS
  Only complete MH post EEN induction predicts more favourable SR for up to 3 years.
authors.affiliation: Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, Australia Department of Gastroenterology, Queensland Children Medical Research institute, Brisbane, Australia zubin.grover@health.wa.gov.au.
authors.forename: Z
authors.initials: Z
authors.lastname: Grover
authors.affiliation: Department of Gastroenterology, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Burgess
authors.affiliation: Department of Gastroenterology, Wesley Hospital, Brisbane, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Muir
authors.affiliation: Department of Gastroenterology, Wesley Hospital, Brisbane, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Reilly
authors.affiliation: Department of Gastroenterology, Wesley Hospital, Brisbane, Australia School of Paediatrics and Child Health, University of Queensland, Brisbane, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lewindon
mesh_terms: D001379:Azathioprine / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D007166:Immunosuppressive Agents; D015122:Mercaptopurine; D001379:Azathioprine
keywords: EEN; mucosal healing; simple endoscopic score for CD