title: The role of exclusive enteral nutrition in the management of orofacial granulomatosis in children.
abstract: BACKGROUND
  Orofacial granulomatosis (OFG) is a term used to describe a persistent, painless swelling of lips and orofacial region. It can be associated with ulceration, gingival hypertrophy and cobble stone appearance of the buccal mucosa. OFG is commonly associated with Crohn's disease and can precede the intestinal manifestation of the disease. Exclusive enteral nutrition (EEN) is a recognized treatment for induction of remission for Crohn's disease. The aim of this study was to review the use of EEN in the management of OFG in children.
  
  
  METHODS
  Retrospective review of medical records of all children diagnosed with OFG between 2007 and 2012 was conducted. Presence of comorbidities, progression to inflammatory bowel disease (IBD) and response to EEN was evaluated.
  
  
  RESULTS
  Twenty-nine children were included, mean age at diagnosis was 9 years (standard deviation 3.9) years. Ten children had isolated OFG and 19 had OFG and IBD, of which 12 presented with OFG and IBD and 7 developed IBD later. Median time to progression to IBD was 33 months (inter quartile range: 9.8-85.5). Twenty-two children completed 6 weeks of EEN, and 19 showed clinical improvement in the OFG appearance.
  
  
  CONCLUSIONS
  EEN appears to be an effective treatment option for children with isolated OFG or OFG and IBD.
authors.affiliation: Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK. mohamed.mutalib@nhs.net.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mutalib
authors.affiliation: Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: Khaled
authors.initials: K
authors.lastname: Bezanti
authors.affiliation: Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: Mamoun
authors.initials: M
authors.lastname: Elawad
authors.affiliation: Department of Pediatric Gastroenterology, Great Ormond Street Hospital, NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
authors.forename: Fevronia
authors.initials: F
authors.lastname: Kiparissi
mesh_terms: D002648:Child; D002681:China; D002908:Chronic Disease; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016208:Databases, Factual; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D051261:Granulomatosis, Orofacial / Q000150:complications / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D012380:Role; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: gastroenterology; inflammation; inflammatory bowel disease; orofacial granulomatosis