Morgan Lawley1, Jessica W Wu1,2, Victor M Navas-López3, Hien Q Huynh1, Matthew W Carroll1, Min Chen1,2, Pavel Medvedev1, Andrew S Day4, Séamus Hussey5, Rotem Sigall-Boneh6, Arie Levine6, Eytan Wine1,7. 1. Edmonton Pediatric IBD Clinic (EPIC), Department of Pediatrics, University of Alberta. 2. Nutrition Services (Child Health), Alberta Health Services, Edmonton, Canada. 3. Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil. IBIMA, Biomedical Institute of Málaga, Málaga, Spain. 4. Department of Paediatrics, University of Otago, Christchurch, New Zealand. 5. National Children's Research Centre, RCSI and UCD, Dublin, Ireland. 6. Pediatric Gastroenterology Unit, Wolfson Medical Center, Tel-Aviv University, Holon, Israel. 7. Department of Physiology, University of Alberta, Edmonton, Canada.
Abstract
OBJECTIVES: Exclusive enteral nutrition (EEN) is an effective induction treatment for pediatric Crohn disease. Given the center-based variation in use and diversity in practice, we constructed a survey aimed at sharing experience and strategies in administering EEN, stimulating further research, and optimizing therapy. METHODS: This survey was constructed after consultation with experts and designed to address key knowledge gaps. The survey was disseminated through the Pediatric IBD Porto Group of ESPGHAN, Canadian Children IBD Network, selective experts, and was sent twice through the Pediatric Gastrointestinal-Bulletin Board (PEDGI-BB). Data were collected into REDCap and analyzed using descriptive statistics. RESULTS: In total, 146 participants from 26 countries completed the survey. Sixty-five percentage of participants were general, non-inflammatory bowel diseases (IBD)-focused pediatric gastroenterologists, 21% were IBD-focused, and 10% were dietitians. The most common indications (∼90% use) were for ileocecal and ileocolonic disease (Paris L1 and L3). The most common duration was 8 weeks and 66% preferred oral to nasogastric administration. Most (63%) did not allow any additional intake and 69% instructed patients to continue partial enteral nutrition (EN) after completing treatment. Dietitians were identified as essential to EEN success while the primary challenges of EEN programs were adherence and lack of support. Regional and professional practice differences were observed in EEN indication, age, exclusivity, program structure/support, and cost coverage. CONCLUSIONS: We found significant variation in practice and use of EEN with several regional and professional differences. Global variation offers opportunities for research and improving care. This survey establishes a framework and provides resources for collaboration and information sharing.
OBJECTIVES: Exclusive enteral nutrition (EEN) is an effective induction treatment for pediatric Crohn disease. Given the center-based variation in use and diversity in practice, we constructed a survey aimed at sharing experience and strategies in administering EEN, stimulating further research, and optimizing therapy. METHODS: This survey was constructed after consultation with experts and designed to address key knowledge gaps. The survey was disseminated through the Pediatric IBD Porto Group of ESPGHAN, Canadian Children IBD Network, selective experts, and was sent twice through the Pediatric Gastrointestinal-Bulletin Board (PEDGI-BB). Data were collected into REDCap and analyzed using descriptive statistics. RESULTS: In total, 146 participants from 26 countries completed the survey. Sixty-five percentage of participants were general, non-inflammatory bowel diseases (IBD)-focused pediatric gastroenterologists, 21% were IBD-focused, and 10% were dietitians. The most common indications (∼90% use) were for ileocecal and ileocolonic disease (Paris L1 and L3). The most common duration was 8 weeks and 66% preferred oral to nasogastric administration. Most (63%) did not allow any additional intake and 69% instructed patients to continue partial enteral nutrition (EN) after completing treatment. Dietitians were identified as essential to EEN success while the primary challenges of EEN programs were adherence and lack of support. Regional and professional practice differences were observed in EEN indication, age, exclusivity, program structure/support, and cost coverage. CONCLUSIONS: We found significant variation in practice and use of EEN with several regional and professional differences. Global variation offers opportunities for research and improving care. This survey establishes a framework and provides resources for collaboration and information sharing.
Authors: Melinda Moriczi; Gemma Pujol-Muncunill; Rafael Martín-Masot; Santiago Jiménez Treviño; Oscar Segarra Cantón; Carlos Ochoa Sangrador; Luis Peña Quintana; Daniel González Santana; Alejandro Rodríguez Martínez; Antonio Rosell Camps; Honorio Armas; Josefa Barrio; Rafael González de Caldas; Mónica Rodríguez Salas; Elena Balmaseda Serrano; Ester Donat Aliaga; Andrés Bodas Pinedo; Esther Vaquero Sosa; Raquel Vecino López; Alfonso Solar Boga; Ana Moreno Álvarez; César Sánchez Sánchez; Mar Tolín Hernani; Carolina Gutiérrez Junquera; Nazareth Martinón Torres; María Rosaura Leis Trabazo; Francisco Javier Eizaguirre; Mónica García Peris; Enrique Medina Benítez; Beatriz Fernández Caamaño; Ana María Vegas Álvarez; Laura Crespo Valderrábano; Carmen Alonso Vicente; Javier Rubio Santiago; Rafael Galera-Martínez; Ruth García-Romero; Ignacio Ros Arnal; Santiago Fernández Cebrián; Helena Lorenzo Garrido; Javier Francisco Viada Bris; Marta Velasco Rodríguez-Belvis; Juan Manuel Bartolomé Porro; Miriam Blanco Rodríguez; Patricia Barros García; Gonzalo Botija; Francisco José Chicano Marín; Enrique La Orden Izquierdo; Elena Crehuá-Gaudiza; Víctor Manuel Navas-López; Javier Martín-de-Carpi Journal: Nutrients Date: 2020-04-07 Impact factor: 5.717
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