Digestive Diseases and Sciences

, Volume 58, Issue 12, pp 3584–3591 | Cite as

Use of Exclusive Enteral Nutrition Is Just as Effective as Corticosteroids in Newly Diagnosed Pediatric Crohn’s Disease

  • Jason Soo
  • Bushra A. Malik
  • Justine M. Turner
  • Rabin Persad
  • Eytan Wine
  • Kerry Siminoski
  • Hien Q. Huynh
Original Article

Abstract

Background

The efficacy of exclusive enteral nutrition (EEN) in induction of remission in pediatric Crohn’s disease (CD) is reported to be equivalent to that of corticosteroids (CS).

Aims

Our objective was to compare the efficacy of EEN and CS in inducing remission in pediatric onset CD and the effects of the treatment on nutritional status and bone mineral density (BMD).

Methods

Medical charts were retrospectively studied for patients diagnosed with CD between 2000 and 2010 at the Stollery children’s hospital in Edmonton, Alberta. Anthropometric and dual-energy X-ray absorptiometry (DXA) data were collected to assess effects of therapy; clinical remission, relapse, and severity were defined on the basis of the pediatric Crohn’s disease activity index.

Results

To induce remission at first presentation, 36 patients (mean age 12.9 years) received EEN and 69 (mean age 11.2 years) received CS. Remission (88.9 % in the EEN group versus 91.3 % in the CS group (p = 0.73) at 3 months) and relapse (40.6 vs. 28.6 %, respectively (p = 0.12) over 12 months) were similar in both treatment groups. Thirty-four patients had paired DXA scans at the time of diagnosis and one year later: 16 given EEN and 18 given CS. Change in BMD spine z-scores based on bone age adjusted for height and chronological age was greater for EEN patients but not statistically significant (Δz-score 0.30 vs. 0.03, p = 0.28).

Conclusions

EEN has similar efficacy to corticosteroids; however, EEN may lead to better BMD accrual. EEN should be preferred to corticosteroids as first-line therapy for induction of remission in pediatric CD.

Keywords

Pediatric Crohn’s disease Nutritional therapy Corticosteroids DXA 

Abbreviation

BA

Bone age

BMC

Bone mineral content

BMD

Bone mineral density

BMAD

Bone mineral apparent density

CD

Crohn’s disease

CS

Corticosteroids

DRIs

Dietary reference intakes

DXA

Dual-energy X-ray absorptiometry

EEN

Exclusive enteral nutrition

IBD

Inflammatory bowel disease

PCDAI

Pediatric Crohn’s disease activity index

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jason Soo
    • 1
  • Bushra A. Malik
    • 1
  • Justine M. Turner
    • 1
  • Rabin Persad
    • 1
  • Eytan Wine
    • 1
  • Kerry Siminoski
    • 2
  • Hien Q. Huynh
    • 1
  1. 1.Division of Pediatric Gastroenterology and Nutrition, Department of PediatricsStollery Children’s HospitalEdmontonCanada
  2. 2.Division of Endocrinology and Metabolism, Department of MedicineUniversity of AlbertaEdmontonCanada

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