Dale Lee1, Robert N Baldassano, Anthony R Otley, Lindsey Albenberg, Anne M Griffiths, Charlene Compher, Eric Z Chen, Hongzhe Li, Erin Gilroy, Lisa Nessel, Amy Grant, Christel Chehoud, Frederic D Bushman, Gary D Wu, James D Lewis. 1. *Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; †Department of Pediatric, Division of Gastroenterology and Nutrition Seattle Children's Hospital, Seattle, Washington; and University of Washington; ‡Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada; §Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; ||School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania; ¶Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; **Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and ††Department of Medicine, Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Therapeutic targets in pediatric Crohn's disease include symptoms, quality of life (QOL), and mucosal healing. Although partial enteral nutrition (PEN), exclusive enteral nutritional (EEN), and anti-tumor necrosis factor alpha (anti-TNF) therapy all improve symptoms, the comparative effectiveness of these approaches to improve QOL and achieve mucosal healing has not been assessed prospectively. METHODS: In a prospective study of children initiating PEN, EEN, or anti-TNF therapy for Crohn's disease, we compared clinical outcomes using the Pediatric Crohn's Disease Activity Index (PCDAI), QOL (IMPACT score), and mucosal healing as estimated by fecal calprotectin (FCP). PCDAI, IMPACT, FCP, and diet (prompted 24-h recall) were measured at baseline and after 8 weeks of therapy. RESULTS: We enrolled 90 children with active Crohn's disease (PCDAI, 33.7 ± 13.7; and FCP, 976 ± 754), of whom 52 were treated with anti-TNF, 22 with EEN, and 16 with PEN plus ad lib diet. Clinical response (PCDAI reduction ≥15 or final PCDAI ≤10) was achieved by 64% on PEN, 88% EEN, and 84% anti-TNF (test for trend P = 0.08). FCP ≤250 μg/g was achieved with PEN in 14%, EEN 45%, and anti-TNF 62% (test for trend P = 0.001). Improvement in overall QOL was not statistically significantly different between the 3 groups (P = 0.86). However, QOL improvement was the greatest with EEN in the body image (P = 0.03) domain and with anti-TNF in the emotional domain (P = 0.04). CONCLUSIONS: Although PEN improved clinical symptoms, EEN and anti-TNF were more effective for decreasing mucosal inflammation and improving specific aspects of QOL.
BACKGROUND: Therapeutic targets in pediatric Crohn's disease include symptoms, quality of life (QOL), and mucosal healing. Although partial enteral nutrition (PEN), exclusive enteral nutritional (EEN), and anti-tumornecrosis factor alpha (anti-TNF) therapy all improve symptoms, the comparative effectiveness of these approaches to improve QOL and achieve mucosal healing has not been assessed prospectively. METHODS: In a prospective study of children initiating PEN, EEN, or anti-TNF therapy for Crohn's disease, we compared clinical outcomes using the Pediatric Crohn's Disease Activity Index (PCDAI), QOL (IMPACT score), and mucosal healing as estimated by fecal calprotectin (FCP). PCDAI, IMPACT, FCP, and diet (prompted 24-h recall) were measured at baseline and after 8 weeks of therapy. RESULTS: We enrolled 90 children with active Crohn's disease (PCDAI, 33.7 ± 13.7; and FCP, 976 ± 754), of whom 52 were treated with anti-TNF, 22 with EEN, and 16 with PEN plus ad lib diet. Clinical response (PCDAI reduction ≥15 or final PCDAI ≤10) was achieved by 64% on PEN, 88% EEN, and 84% anti-TNF (test for trend P = 0.08). FCP ≤250 μg/g was achieved with PEN in 14%, EEN 45%, and anti-TNF 62% (test for trend P = 0.001). Improvement in overall QOL was not statistically significantly different between the 3 groups (P = 0.86). However, QOL improvement was the greatest with EEN in the body image (P = 0.03) domain and with anti-TNF in the emotional domain (P = 0.04). CONCLUSIONS: Although PEN improved clinical symptoms, EEN and anti-TNF were more effective for decreasing mucosal inflammation and improving specific aspects of QOL.
Authors: James D Lewis; Lindsey Albenberg; Dale Lee; Mario Kratz; Klaus Gottlieb; Walter Reinisch Journal: Inflamm Bowel Dis Date: 2017-02 Impact factor: 5.325
Authors: Josephine Ni; Ting-Chin David Shen; Eric Z Chen; Kyle Bittinger; Aubrey Bailey; Manuela Roggiani; Alexandra Sirota-Madi; Elliot S Friedman; Lillian Chau; Andrew Lin; Ilana Nissim; Justin Scott; Abigail Lauder; Christopher Hoffmann; Gloriany Rivas; Lindsey Albenberg; Robert N Baldassano; Jonathan Braun; Ramnik J Xavier; Clary B Clish; Marc Yudkoff; Hongzhe Li; Mark Goulian; Frederic D Bushman; James D Lewis; Gary D Wu Journal: Sci Transl Med Date: 2017-11-15 Impact factor: 17.956
Authors: James D Lewis; Eric Z Chen; Robert N Baldassano; Anthony R Otley; Anne M Griffiths; Dale Lee; Kyle Bittinger; Aubrey Bailey; Elliot S Friedman; Christian Hoffmann; Lindsey Albenberg; Rohini Sinha; Charlene Compher; Erin Gilroy; Lisa Nessel; Amy Grant; Christel Chehoud; Hongzhe Li; Gary D Wu; Frederic D Bushman Journal: Cell Host Microbe Date: 2015-10-14 Impact factor: 21.023
Authors: Sean R Llewellyn; Graham J Britton; Eduardo J Contijoch; Olivia H Vennaro; Arthur Mortha; Jean-Frederic Colombel; Ari Grinspan; Jose C Clemente; Miriam Merad; Jeremiah J Faith Journal: Gastroenterology Date: 2017-11-23 Impact factor: 22.682