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Repeated exclusive enteral nutrition in the treatment of pediatric Crohn's disease

This month's Alimentary Pharmacology & Therapeutics identifies predictors of efficacy and outcome of repeated exclusive enteral nutrition in the treatment of pediatric Crohn's disease.

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Exclusive enteral nutrition induces remission and mucosal healing in children with active Crohn's disease.

Dr Schwerd and colleagues from Germany compared short- and long-term outcomes of the first vs second courses of exclusive enteral nutrition, and identified predictors of sustained remission.

The researchers performed a retrospective single center analysis of all patients with Crohn's disease treated with exclusive enteral nutrition over 7.5 years.

Patients were excluded if exposed to anti-TNFα or corticosteroids 3 months prior to exclusive enteral nutrition.

Data included disease phenotype, activity, NOD2 genotype, laboratory indices and anthropometrics.

The team defined remission and relapse by mathematically weighted Paediatric Crohn's Disease Activity Index (wPCDAI) with 1-year follow-up.

Fecal calprotectin more than 200 μg/g during enteral nutrition was associated with shorter remission
Alimentary Pharmacology & Therapeutics

Of 94 patients treated with exclusive enteral nutrition, 52 fulfilled inclusion criteria.

The research team reported that azathioprine was started within the first month in 33/52 patients.

The researchers noted that 26/52 received a second exclusive enteral nutrition course.

First compared to second exclusive enteral nutrition revealed higher wPCDAI at start, tended to higher remission rates after 3 months, but showed comparable 1-year relapse rates.

The team noted that disease activity, weight gain and inflammatory markers showed better improvement with first exclusive enteral nutrition.

Fecal calprotectin more than 200 μg/g during exclusive enteral nutrition was associated with shorter remission.

The research team observed that certain NOD2 genotypes were related to higher relapse rates.

Dr Schwerd's team concludes, "Exclusive enteral nutrition induces remission in active Crohn's disease, but efficacy tends to decrease with the second course."

"Despite early azathioprine use, 1-year relapse rates are high, but may be related to NOD2 genotype."

Aliment Pharmacol Ther 2014: 39(12): 1398–1407
03 June 2014

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