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Use of Exclusive Enteral Nutrition Is Just as Effective as Corticosteroids in Newly Diagnosed Pediatric Crohn’s Disease

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Abstract

Background

The efficacy of exclusive enteral nutrition (EEN) in induction of remission in pediatric Crohn’s disease (CD) is reported to be equivalent to that of corticosteroids (CS).

Aims

Our objective was to compare the efficacy of EEN and CS in inducing remission in pediatric onset CD and the effects of the treatment on nutritional status and bone mineral density (BMD).

Methods

Medical charts were retrospectively studied for patients diagnosed with CD between 2000 and 2010 at the Stollery children’s hospital in Edmonton, Alberta. Anthropometric and dual-energy X-ray absorptiometry (DXA) data were collected to assess effects of therapy; clinical remission, relapse, and severity were defined on the basis of the pediatric Crohn’s disease activity index.

Results

To induce remission at first presentation, 36 patients (mean age 12.9 years) received EEN and 69 (mean age 11.2 years) received CS. Remission (88.9 % in the EEN group versus 91.3 % in the CS group (p = 0.73) at 3 months) and relapse (40.6 vs. 28.6 %, respectively (p = 0.12) over 12 months) were similar in both treatment groups. Thirty-four patients had paired DXA scans at the time of diagnosis and one year later: 16 given EEN and 18 given CS. Change in BMD spine z-scores based on bone age adjusted for height and chronological age was greater for EEN patients but not statistically significant (Δz-score 0.30 vs. 0.03, p = 0.28).

Conclusions

EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.

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Abbreviations

BA:

Bone age

BMC:

Bone mineral content

BMD:

Bone mineral density

BMAD:

Bone mineral apparent density

CD:

Crohn’s disease

CS:

Corticosteroids

DRIs:

Dietary reference intakes

DXA:

Dual-energy X-ray absorptiometry

EEN:

Exclusive enteral nutrition

IBD:

Inflammatory bowel disease

PCDAI:

Pediatric Crohn’s disease activity index

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Acknowledgments

We thank our nurses Cheryl Kluthe, Gail Dehaan, and Leanne Shirton, and our dietician Jessica Sawyer-Bennett for their help in collecting the data. This study was funded in part by Nestlé, Canada, as an investigator-initiated study.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, T6G 2J3, Canada

    Jason Soo, Bushra A. Malik, Justine M. Turner, Rabin Persad, Eytan Wine & Hien Q. Huynh

  2. Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Canada

    Kerry Siminoski

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  1. Jason Soo
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Correspondence to Hien Q. Huynh.

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Soo, J., Malik, B.A., Turner, J.M. et al. Use of Exclusive Enteral Nutrition Is Just as Effective as Corticosteroids in Newly Diagnosed Pediatric Crohn’s Disease. Dig Dis Sci 58, 3584–3591 (2013). https://doi.org/10.1007/s10620-013-2855-y

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  • DOI: https://doi.org/10.1007/s10620-013-2855-y

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