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Exclusive enteral nutrition effect on the clinical course of pediatric Crohn’s disease: a single center experience

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An Editorial to this article was published on 02 November 2020

Abstract

The aim of this study was to evaluate the short- and long-term outcomes of exclusive enteral nutrition (EEN) versus corticosteroids (CS) as induction therapy, in a cohort of pediatric patients with Crohn’s disease (CD). A retrospective study of patients with CD has been conducted. Clinical characteristics, laboratory parameters, and pediatric Crohn’s disease activity index (PCDAI) were evaluated at diagnosis and at different follow-up points. Subjects were divided in EEN-induction group, receiving EEN, and CS-induction group, treated with oral CS. We evaluated 47 patients in the EEN-induction group and 21 patients in the CS-induction group. After 8 weeks from diagnosis, we detected a significant improvement in CRP (p = 0.001) and albumin (p = 0.05), in EEN-induction group compared with the CS-induction group. PCDAI was significantly lower in the EEN-induction group versus the CS-induction group after 8 weeks (p = 0.04) and 1 year (p = 0.03) of follow-up. After 2 years from diagnosis, the number of subjects needing immunomodulators (IMM, azathioprine or methotrexate) was significantly higher in the CS-induction group compared with the EEN-induction group (p = 0.02).

Conclusion: EEN has the same effectiveness of CS therapy in induction of remission but seems to have a more pronounced effect on disease activity. In our cohort, the need to use IMM seems to be reduced in subjects initially treated with EEN.

What is Known:

• Exclusive enteral nutrition (EEN) has the same effectiveness of corticosteroids (CS) in the induction of remission in pediatric Crohn’s disease.

• EEN offers numerous advantages over CS, in terms of improved nutrition and mucosal healing.

What is New:

• Induction of remission with EEN seems to have a more pronounced effect on disease activity compared to induction with CS.

• In our cohort, induction of remission with EEN seems to reduce the need of therapy with immunomodulators at 2 years of follow-up.

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Abbreviations

AZT:

Azathioprine

BMI:

Body mass index

CD:

Crohn’s disease

CS:

Corticosteroids

ECCO:

European Crohn’s and Colitis Organization

EEN:

Exclusive enteral nutrition

EIM:

Extra-intestinal manifestations

ESPGHAN:

European Society for Pediatric Gastroenterology, Hepatology and Nutrition

IFX:

Infliximab

PCDAI:

Pediatric Crohn’s Disease Activity Index

IMM:

Immunomodulators

MTX:

Methotrexate

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Author notes

  1. Elena Scarpato, Caterina Strisciuglio and Massimo Martinelli contributed equally to this work.

Authors and Affiliations

  1. Department of Translational Medical Sciences – Section of Paediatrics, University of Naples “Federico II”, Via S. Pansini 5, 80131, Naples, Italy

    Elena Scarpato, Massimo Martinelli, Marina Russo, Sabrina Cenni, Maria Rosaria Serra, Annamaria Staiano & Erasmo Miele

  2. Department of Women, Child and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Caterina Strisciuglio & Marianna Casertano

Authors
  1. Elena Scarpato
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  2. Caterina Strisciuglio
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  4. Marina Russo
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Contributions

E.S: Dr. Scarpato conceptualized the study, acquired the data, performed the data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Scarpato agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

C.S.: Dr. Strisciuglio conceptualized the study, acquired the data, performed the data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Strisciuglio agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

M. M.: Dr. Martinelli conceptualized the study, performed the data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Martinelli agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

M. R.: Dr. Russo acquired the data, performed the data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Russo agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

S. C.: Dr. Cenni acquired the data, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Cenni agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

M. C.: Dr. Casertano acquired the data, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Casertano agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

M. R. S.: Dr. Serra acquired the data, performed the data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Serra agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

A. S.: Dr. Staiano contributed to conception of the study, revised the article critically for important intellectual content, and approved the final manuscript as submitted. Dr. Staiano agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

E. M.: Dr. Miele contributed to conception of the study, revised the article critically for important intellectual content, and approved the final manuscript as submitted. Dr. Miele agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Annamaria Staiano.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The Institutional Review Board of the University of Naples “Federico II” approved the study protocol and questionnaire with the registration number 128/18. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Scarpato, E., Strisciuglio, C., Martinelli, M. et al. Exclusive enteral nutrition effect on the clinical course of pediatric Crohn’s disease: a single center experience. Eur J Pediatr 179, 1925–1934 (2020). https://doi.org/10.1007/s00431-020-03753-x

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  • DOI: https://doi.org/10.1007/s00431-020-03753-x

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