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Enteral nutrition combined with modified diet promotes endoscopic remission in pediatric Crohn's disease

Crohn's disease Crohn's disease
Crohn's disease Crohn's disease

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For inducing remission in pediatric Crohn’s illness, partial enteral nutrition in combination with Crohn’s illness exclusion diet, adapted to align with the local culinary preferences, appears to be as efficacious as exclusive enteral nutrition.

In a pioneering study conducted at a leading tertiary center, researchers have found that Partial Enteral Nutrition (PEN) coupled with a modified Crohn's Disease Exclusion Diet (mCDED) holds promise for inducing endoscopic remission and mucosal healing in pediatric patients suffering from Crohn's disease (CD). This pilot prospective cohort trial focused on children with active CD and compared the efficacy of PEN + mCDED with Exclusive Enteral Nutrition (EEN).

Throughout the research period, 54 patients underwent screening, and 15 were excluded based on predetermined criteria, including six who were removed within the initial two days due to their inability to tolerate the enteral formula. The study comprised 14 volunteers in the PEN group and 19 in the EEN group. Evaluations were conducted at weeks 0, 1, 3, and 6, utilizing both clinical and lab parameters. Endoscopic examinations took place at both week 0 and week 6.

Key findings:

  1. Clinical Remission Rates: Clinical remission rates, as examined by lab and clinical parameters, were comparable between the PEN and EEN groups, with 84.6% in the PEN group and 81.3% in the EEN group.
  2. Endoscopic Response: An impressive endoscopic response, defined as a reduction in the Simple Endoscopic Score for CD (SES-CD) of more than 50%, was witnessed in 84.6% of patients on PEN compared to 68.8% on EEN treatment at week 6.
  3. Endoscopic Remission and Mucosal Healing: Endoscopic remission (SES-CD ≤ 2) was attained in 53.8% of  volunteers  in the PEN group and 50.0% in the EEN group. On the other hand, the rates of mucosal restoration (SES-CD = 0) were 38.5% in the PEN group and 43.8% in the EEN group.
  4. Tolerance and Adherence: Six volunteers were eliminated in the first two days owing to enteral formula intolerance, emphasizing the importance of patient tolerance and adherence to the treatment.
  5. Clinical and Endoscopic Activity Scores: Both groups exhibited a considerable decline in clinical and endoscopic activity scores, underscoring the effectiveness of both PEN + mCDED and EEN in treating pediatric CD.

Hence, PEN + mCDED appears to be a viable alternative to induce endoscopic remission and mucosal healing in active CD-affected pediatrics. This real-world experience provides valuable insights into the potential benefits of this novel approach, opening novel avenues for the management of CD in the pediatric population.

Source:

Nutrients

Article:

Treatment of Active Crohn's Disease in Children Using Partial Enteral Nutrition Combined with a Modified Crohn's Disease Exclusion Diet: A Pilot Prospective Cohort Trial on Clinical and Endoscopic Outcomes

Authors:

Darja Urlep et al.

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