Exclusive enteral nutrition continues to be first line therapy for pediatric Crohns disease in the era of biologics [La nutrición enteral exclusiva continua siendo el tratamiento de primera línea en la enfermedad de Crohn pediátrica en la era de los biológicos]
Navas-Lopez V.M.,Hospital Materno InfantilMalaga |
Navas-Lopez V.M.,Institute Investigacion Biomedica Of Malaga Ibima Malaga |
Blasco-Alonso J.,Hospital Materno InfantilMalaga |
Blasco-Alonso J.,Institute Investigacion Biomedica Of Malaga Ibima Malaga |
And 6 more authors.
Anales de Pediatria | Year: 2015
Abstract Introduction Exclusive enteral nutrition (EEN) has been to be more effective than corticosteroids in achieving mucosal healing without their side effects. Objectives To determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation. Materials and methods The medical records of patients with newly diagnosed Crohn's disease treated with EEN were reviewed retrospectively. The degree of mucosal inflammation was assessed by fecal calprotectin (FC). Remission was defined as a PCDAI < 10. Results Forty patients (24 males) were included, the age at diagnosis was 11.6 ± 3.6 years. Of the 34 patients who completed the EEN period, 32 (94% per-protocol analysis) achieved clinical remission. This percentage fell to 80% in the intention-to-treat analysis. The compliance rate was 95%. Duration of EEN was 6.42 weeks (IQR 6.0-8.14). FC was significantly higher in patients with moderate and severe disease. Median baseline FC levels (680 μg/g) decreased significantly to 218 μg/g (P < 0.0001) after EEN. We found a statistically significant correlation between FC and PCDAI (rho = 0.727; P < 0.0001). Early use of thiopurines (< 8 weeks) versus subsequent use was not associated with improved outcomes during the follow-up. Conclusions EEN administered for 6-8 weeks is effective for inducing clinical remission and decreasing the degree of mucosal inflammation. We did not find differences in terms of maintenance of remission in patients treated early with thiopurines. © 2013 Asociación Española de Pediatría.