Noa Cohen-Dolev1, Malgorata Sladek2, Seamus Hussey3, Dan Turner4, Gabor Veres5, Sibylle Koletzko6, Javier Martin de Carpi7, Annamaria Staiano8, Ron Shaoul9, Paolo Lionetti10, Jorge Amil Dias11, Anders Paerregaard12, Federica Nuti13, Tamar Pfeffer Gik1, Tomer Ziv-Baran14, Sivan Ben Avraham Shulman1, Chen Sarbagili Shabat1, Rotem Sigall Boneh1, Richard K Russell15, Arie Levine1,16. 1. Pediatric Gastroenterology and Nutrition Unit, Wolfson Medical Center, Holon, Israel. 2. Jagiellonian University Medical College, Krakow, Poland. 3. National Children's Research Centre, Crumlin; Department of Paediatrics, UCD and RCSI, Dublin, Ireland. 4. Juliet Keidan Institute of Paediatric Gastroenterology, Hebrew University of Jerusalem, Jerusalem, Israel. 5. First Department of Pediatrics, Semmelweis University, Budapest, Hungary. 6. Ludwig Maximilians-Universität München, Dr von Hauner Children's Hospital, Munich, Germany. 7. Department of Gastroenterology, Hepatology and Pediatric Nutrition, Hospital Sant Joan de Deu, Barcelona, Spain. 8. Department of Translational Medical Science, University of Naples 'Federico II', Naples, Italy. 9. Pediatric Gastroenterology Institute, Rambam Medical Center, Haifa, Israel. 10. Paediatric Gastroenterology Unit, University of Florence-Meyer Hospital, Florence, Italy. 11. Pediatric Gastroenterology Unit, Centro Hospitalar de São João, Porto, Portugal. 12. Department of Paediatrics 460, Hvidovre University Hospital, Hvidovre, Denmark. 13. Pediatric Gastroenterology and Hepatology Unit, Sapienza University, Rome, Italy. 14. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 15. Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK. 16. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abstract
BACKGROUND: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. METHODS: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. RESULTS: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. CONCLUSIONS: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.
BACKGROUND: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. METHODS: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. RESULTS: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. CONCLUSIONS: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.
Authors: You-You Luo; You-Hong Fang; Jin-Dan Yu; Luo-Jia Xu; Ming-Fang Sun; Qi Cheng; Jie Chen Journal: Zhongguo Dang Dai Er Ke Za Zhi Date: 2022-06-15
Authors: Shuai Wang; Rene Martins; Megan C Sullivan; Elliot S Friedman; Ana M Misic; Ayah El-Fahmawi; Elaine Cristina Pereira De Martinis; Kevin O'Brien; Ying Chen; Charles Bradley; Grace Zhang; Alexander S F Berry; Christopher A Hunter; Robert N Baldassano; Mark P Rondeau; Daniel P Beiting Journal: Microbiome Date: 2019-08-31 Impact factor: 14.650