Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with Crohn's disease

Authors

  • F. L. Cameron,

    1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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  • K. Gerasimidis,

    1. Life course Nutrition and Health, Centre for Population and Health Sciences, Institute of Health and Wellbeing, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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  • A. Papangelou,

    1. Life course Nutrition and Health, Centre for Population and Health Sciences, Institute of Health and Wellbeing, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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  • D. Missiou,

    1. Life course Nutrition and Health, Centre for Population and Health Sciences, Institute of Health and Wellbeing, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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  • V. Garrick,

    1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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  • T. Cardigan,

    1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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  • E. Buchanan,

    1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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  • A. R. Barclay,

    1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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  • P. McGrogan,

    1. Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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  • R. K. Russell

    Corresponding author
    • Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Sick Children, Glasgow, UK
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Correspondence to:

Dr R. K. Russell, Department of Paediatric Gastroenterology, Yorkhill Hospital, Dalnair Street, Glasgow G3 8SJ, UK.

E-mail: richardrussell@nhs.net

Summary

Background

Exclusive enteral nutrition (EEN) is an effective first line treatment for active paediatric Crohn's disease (CD).

Aim

To examine the effect of EEN on short- and long-term clinical outcome together with anthropometric measurements.

Methods

Retrospective case-note review in newly diagnosed CD (<16 years) who completed 8 weeks of EEN. Demographics, anthropometry, disease characteristics and inflammatory markers were collected at EEN initiation and at 1, 2, 6, 12 & 24 months post treatment initiation. EEN response was determined by a patient global assessment.

Results

One hundred and nine patients were included (Males 68; Median age: 11.2 years). After 8 weeks EEN, 65 were in remission, 32 improved and 12 had no improvement. By 4 weeks, mean weight/BMI z-score (s.d.) increased (P < 0.02) and between 4 and 8 weeks (P < 0.05). Baseline inflammatory markers all improved significantly by week 4 (albumin, CRP and platelets; all P < 0.01) and ESR (P < 0.00001). 63/109(58%) relapsed during follow-up. 44/63(70%) patients completed a second course of EEN with similar response rate, but lower weight gain (3.3 vs. 5.1 kg, P < 0.05). Height z-score did not change significantly over the 24 months. Introduction of azathioprine within 6 months of diagnosis did not improve height outcomes at 24 months.

Conclusions

Weight and BMI z-score improved with EEN and changes are sustained to 2 years, but height z-score did not. Seventy per cent of patients who relapsed during 2-year follow-up managed a 2nd course of EEN. The optimal therapeutic strategies for length of EEN course and to improve linear growth are awaited.

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