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Nutritional Management of Inflammatory Bowel Disease

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Pediatric Inflammatory Bowel Disease

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Abstract

Pediatric inflammatory bowel disease (IBD), particularly Crohn disease can have a significant impact on nutritional status. The following chapter reviews the nutritional implications and general management of nutritional status in pediatric IBD. In addition, exclusive enteral nutrition therapy is a highly effective yet underutilized form of therapy for pediatric Crohn disease. The bulk of the chapter will concentrate on this form of therapy, detailing the history of its use and postulated mechanisms of action. The efficacy in both induction and maintenance of remission will be reviewed as well as the geographic variability and barriers to the utilization of enteral nutrition therapy.

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References

  1. Griffiths A. Inflammatory Bowel Disease; Chapter 41; Pediatric Gastrointestinal Disease. 3rd ed., W.A.D.P.H.J.et al. editors. Hamilton: BC Decker; 2000.

    Google Scholar 

  2. Seidman E, et al. Nutritional issues in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1991;12(4):424–38.

    Article  PubMed  CAS  Google Scholar 

  3. Kanof ME, Lake AM, Bayless TM. Decreased height velocity in children and adolescents before the diagnosis of Crohn’s disease. Gastroenterology. 1988;95(6):1523–7.

    PubMed  CAS  Google Scholar 

  4. Levine A, et al. Consensus and controversy in the management of pediatric Crohn disease: an international survey. J Pediatr Gastroenterol Nutr. 2003;36(4):464–9.

    Article  PubMed  Google Scholar 

  5. Jakobsen C, et al. Pediatric inflammatory bowel disease: increasing incidence, decreasing surgery rate, and compromised nutritional status: a prospective population-based cohort study 2007–2009. Inflamm Bowel Dis. 2011;17(12):2541–50.

    Article  PubMed  Google Scholar 

  6. Aurangzeb B, et al. Assessment of nutritional status and serum leptin in children with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2011;52(5):536–41.

    Article  PubMed  CAS  Google Scholar 

  7. Kugathasan S, et al. Body mass index in children with newly diagnosed inflammatory bowel disease: observations from two multicenter North American inception cohorts. J Pediatr. 2007;151(5):523–7.

    Article  PubMed  Google Scholar 

  8. Kelts DG, et al. Nutritional basis of growth failure in children and adolescents with Crohn’s disease. Gastroenterology. 1979;76(4): 720–7.

    PubMed  CAS  Google Scholar 

  9. Kirschner BS, et al. Reversal of growth retardation in Crohn’s disease with therapy emphasizing oral nutritional restitution. Gastroenterology. 1981;80(1):10–5.

    PubMed  CAS  Google Scholar 

  10. Kirschner BS, Voinchet O, Rosenberg IH. Growth retardation in inflammatory bowel disease. Gastroenterology. 1978;75(3):504–11.

    PubMed  CAS  Google Scholar 

  11. Motil KJ, Altchuler SI, Grand RJ. Mineral balance during nutritional supplementation in adolescents with Crohn disease and growth failure. J Pediatr. 1985;107(3):473–9.

    Article  PubMed  CAS  Google Scholar 

  12. Motil KJ, et al. The effect of disease, drug, and diet on whole body protein metabolism in adolescents with Crohn disease and growth failure. J Pediatr. 1982;101(3):345–51.

    Article  PubMed  CAS  Google Scholar 

  13. Thomas AG, Taylor F, Miller V. Dietary intake and nutritional treatment in childhood Crohn’s disease. J Pediatr Gastroenterol Nutr. 1993;17(1):75–81.

    Article  PubMed  CAS  Google Scholar 

  14. Shamir R, Philip M, Levine A. Growth retardation in pediatric Crohn’s disease: pathogenesis and interventions. Inflamm Bowel Dis. 2001;13:620–8.

    Article  Google Scholar 

  15. Kleinman RE, et al. Nutrition support for pediatric patients with inflammatory bowel disease: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology And Nutrition. J Pediatr Gastroenterol Nutr. 2004;39(1):15–27.

    Article  PubMed  Google Scholar 

  16. Thayu M, et al. Determinants of changes in linear growth and body composition in incident pediatric Crohn’s disease. Gastroenterology. 2010;139(2):430–8.

    Article  PubMed  Google Scholar 

  17. Azcue M, et al. Energy expenditure and body composition in children with Crohn’s disease: effect of enteral nutrition and treatment with prednisolone. Gut. 1997;41(2):203–8.

    Article  PubMed  CAS  Google Scholar 

  18. Zoli G, et al. Effect of oral elemental diet on nutritional status, intestinal permeability and disease activity in Crohn’s patients. Gastroenterology. 1996;110(4):A1054.

    Google Scholar 

  19. Pons R, et al. Dietary intakes of children with Crohn’s disease. Br J Nutr. 2009;102(7):1052–7.

    Article  PubMed  CAS  Google Scholar 

  20. Burnham JM, et al. Body-composition alterations consistent with cachexia in children and young adults with Crohn disease. Am J Clin Nutr. 2005;82(2):413–20.

    PubMed  CAS  Google Scholar 

  21. Wiskin AE, et al. Body composition in childhood inflammatory bowel disease. Clin Nutr. 2011;30(1):112–5.

    Article  PubMed  Google Scholar 

  22. Thayu M, et al. Gender differences in body composition deficits at diagnosis in children and adolescents with Crohn’s disease. Inflamm Bowel Dis. 2007;13(9):1121–8.

    Article  PubMed  Google Scholar 

  23. Sylvester FA, et al. A two-year longitudinal study of persistent lean tissue deficits in children with Crohn’s disease. Clin Gastroenterol Hepatol. 2009;7(4):452–5.

    Article  PubMed  Google Scholar 

  24. Hannon TS, et al. Acute effects of enteral nutrition on protein turnover in adolescents with Crohn disease. Pediatr Res. 2007;61(3):356–60.

    Article  PubMed  CAS  Google Scholar 

  25. Levin AD, et al. Vitamin D deficiency in children with inflammatory bowel disease. Dig Dis Sci. 2011;56(3):830–6.

    Article  PubMed  CAS  Google Scholar 

  26. Trebble TM, et al. Essential fatty acid status in paediatric Crohn’s disease: relationship with disease activity and nutritional status. Aliment Pharmacol Ther. 2003;18(4):433–42.

    Article  PubMed  CAS  Google Scholar 

  27. Driscoll Jr RH, et al. Vitamin D deficiency and bone disease in patients with Crohn’s disease. Gastroenterology. 1982;83(6):1252–8.

    PubMed  Google Scholar 

  28. Geerling BJ, et al. Comprehensive nutritional status in patients with long-standing Crohn disease currently in remission. Am J Clin Nutr. 1998;67(5):919–26.

    PubMed  CAS  Google Scholar 

  29. Gerasimidis K, et al. Impact of exclusive enteral nutrition on body composition and circulating micronutrients in plasma and erythrocytes of children with active Crohn’s disease. Inflamm Bowel Dis. 2012;18(9):1672–81.

    Article  PubMed  Google Scholar 

  30. Van Gossum A, et al. ESPEN Guidelines on parenteral nutrition: gastroenterology. Clin Nutr. 2009;28(4):415–27.

    Article  PubMed  Google Scholar 

  31. Kleinman RE, et al. Nutritional support for pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1989;8(1):8–12.

    Article  PubMed  CAS  Google Scholar 

  32. Sondike S. Weight status in pediatric IBD patients at the time of diagnosis: effects of the obesity epidemic. J Pediatr Gastroenterol Nutr. 2004;39 Suppl 1:S317.

    Article  Google Scholar 

  33. Long MD, et al. Prevalence and epidemiology of overweight and obesity in children with inflammatory bowel disease. Inflamm Bowel Dis. 2011;17(10):2162–8.

    Article  PubMed  Google Scholar 

  34. Teahon K, et al. Alterations in nutritional status and disease activity during treatment of Crohn’s disease with elemental diet. Scand J Gastroenterol. 1995;30(1):54–60.

    Article  PubMed  CAS  Google Scholar 

  35. Grinspoon S, et al. Serum leptin levels in women with anorexia nervosa. J Clin Endocrinol Metab. 1996;81(11):3861–3.

    Article  PubMed  CAS  Google Scholar 

  36. Hassink SG, et al. Serum leptin in children with obesity: relationship to gender and development. Pediatrics. 1996;98(2 Pt 1):201–3.

    PubMed  CAS  Google Scholar 

  37. Singhal A, et al. Early nutrition and leptin concentrations in later life. Am J Clin Nutr. 2002;75(6):993–9.

    PubMed  CAS  Google Scholar 

  38. Soliman AT, et al. Serum leptin concentrations during severe protein-energy malnutrition: correlation with growth parameters and endocrine function. Metabolism. 2000;49(7):819–25.

    Article  PubMed  CAS  Google Scholar 

  39. Hoppin AG, et al. Serum leptin in children and young adults with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 1998;26(5):500–5.

    Article  PubMed  CAS  Google Scholar 

  40. Gokhale R, et al. Bone mineral density assessment in children with inflammatory bowel disease. Gastroenterology. 1998;114(5):902–11.

    Article  PubMed  CAS  Google Scholar 

  41. Compston JE. Management of bone disease in patients on long term glucocorticoid therapy. Gut. 1999;44(6):770–2.

    Article  PubMed  CAS  Google Scholar 

  42. Hyams JS, Carey DE. Corticosteroids and growth. J Pediatr. 1988;113(2):249–54.

    Article  PubMed  CAS  Google Scholar 

  43. Franklin JL, Rosenberg HH. Impaired folic acid absorption in inflammatory bowel disease: effects of salicylazosulfapyridine (Azulfidine). Gastroenterology. 1973;64(4):517–25.

    PubMed  CAS  Google Scholar 

  44. Feagan BG, et al. Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators. N Engl J Med. 1995;332(5):292–7.

    Article  PubMed  CAS  Google Scholar 

  45. Fridge J. The specific carbohydrate diet—a treatment for Crohn’s disease? J Pediatr Gastroenterol Nutr. 2004;39 Suppl 1:S299.

    Article  Google Scholar 

  46. Ritchie JK, et al. Controlled multicentre therapeutic trial of an unrefined carbohydrate, fibre rich diet in Crohn’s disease. Br Med J (Clin Res Ed). 1987;295(6597):517–20.

    Article  CAS  Google Scholar 

  47. Levenstein S, et al. Low residue or normal diet in Crohn’s disease: a prospective controlled study in Italian patients. Gut. 1985;26(10):989–93.

    Article  PubMed  CAS  Google Scholar 

  48. Griffiths AM. Inflammatory bowel disease. Nutrition. 1998;14(10): 788–91.

    Article  PubMed  CAS  Google Scholar 

  49. Brown AC, Rampertab SD, Mullin GE. Existing dietary guidelines for Crohn’s disease and ulcerative colitis. Expert Rev Gastroenterol Hepatol. 2011;5(3):411–25.

    Article  PubMed  Google Scholar 

  50. Wedrychowicz A, et al. Serum concentrations of VEGF and TGF-beta1 during exclusive enteral nutrition in IBD. J Pediatr Gastroenterol Nutr. 2011;53(2):150–5.

    Article  PubMed  CAS  Google Scholar 

  51. Voitk AJ, et al. Experience with elemental diet in the treatment of inflammatory bowel disease. Is this primary therapy? Arch Surg. 1973;107(2):329–33.

    Article  PubMed  CAS  Google Scholar 

  52. O’Morain CA, Segal AW, Levi AJ. Elemental diet as primary treatment of acute Crohn’s disease: a controlled trial. Br Med J (Clin Res Ed). 1984;288(6434):1859–62.

    Article  Google Scholar 

  53. Sanderson IR, et al. Remission induced by an elemental diet in small bowel Crohn’s disease. Arch Dis Child. 1987;62(2):123–7.

    Article  PubMed  CAS  Google Scholar 

  54. Lionetti P, et al. Enteral nutrition and microflora in pediatric Crohn’s disease. JPEN J Parenter Enteral Nutr. 2005;29 Suppl 4:S173–5. discussion S175-8, S184-8.

    Article  PubMed  Google Scholar 

  55. Pryce-Millar E, Murch SH, Heuschkel RB, et al. Enteral nutrition therapy in Crohn’s disease changes the mucosal flora. JPGN. 2004;39 Suppl 1:289.

    Google Scholar 

  56. Leach ST, et al. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn’s disease. Aliment Pharmacol Ther. 2008;28(6):724–33.

    Article  PubMed  CAS  Google Scholar 

  57. Kajiura T, et al. Change of intestinal microbiota with elemental diet and its impact on therapeutic effects in a murine model of chronic colitis. Dig Dis Sci. 2009;54(9):1892–900.

    Article  PubMed  CAS  Google Scholar 

  58. Smith AR, et al. Microbiological and immunological effects of enteral feeding on the upper gastrointestinal tract. J Med Microbiol. 2011;60(Pt 3):359–65.

    Article  PubMed  Google Scholar 

  59. Whelan K, et al. Fecal microbiota in patients receiving enteral feeding are highly variable and may be altered in those who develop diarrhea. Am J Clin Nutr. 2009;89(1):240–7.

    Article  PubMed  CAS  Google Scholar 

  60. Meister D, et al. Anti-inflammatory effects of enteral diet components on Crohn’s disease-affected tissues in vitro. Dig Liver Dis. 2002;34(6):430–8.

    Article  PubMed  CAS  Google Scholar 

  61. de Jong NS, Leach ST, Day AS. Polymeric formula has direct anti-inflammatory effects on enterocytes in an in vitro model of intestinal inflammation. Dig Dis Sci. 2007;52(9):2029–36.

    Article  PubMed  CAS  Google Scholar 

  62. Hollander D. The intestinal permeability barrier. A hypothesis as to its regulation and involvement in Crohn’s disease. Scand J Gastroenterol. 1992;27(9):721–6.

    Article  PubMed  CAS  Google Scholar 

  63. Teahon K, et al. Intestinal permeability in patients with Crohn’s disease and their first degree relatives. Gut. 1992;33(3):320–3.

    Article  PubMed  CAS  Google Scholar 

  64. Suenaert P, et al. Anti-tumor necrosis factor treatment restores the gut barrier in Crohn’s disease. Am J Gastroenterol. 2002;97(8):2000–4.

    Article  PubMed  CAS  Google Scholar 

  65. Guzy C, et al. Enteral and parenteral nutrition distinctively modulate intestinal permeability and T cell function in vitro. Eur J Nutr. 2009;48(1):12–21.

    Article  PubMed  CAS  Google Scholar 

  66. Nahidi L, et al. Differential effects of nutritional and non-nutritional therapies on intestinal barrier function in an in vitro model. J Gastroenterol. 2012;47(2):107–17.

    Article  PubMed  CAS  Google Scholar 

  67. Gorard DA, et al. Initial response and subsequent course of Crohn’s disease treated with elemental diet or prednisolone. Gut. 1993;34(9):1198–202.

    Article  PubMed  CAS  Google Scholar 

  68. Lindor KD, et al. A randomized prospective trial comparing a defined formula diet, corticosteroids, and a defined formula diet plus corticosteroids in active Crohn’s disease. Mayo Clin Proc. 1992;67(4):328–33.

    PubMed  CAS  Google Scholar 

  69. Lochs H, et al. Comparison of enteral nutrition and drug treatment in active Crohn’s disease. Results of the European Cooperative Crohn’s Disease Study. IV. Gastroenterology. 1991;101(4):881–8.

    PubMed  CAS  Google Scholar 

  70. Malchow H, et al. European Cooperative Crohn’s Disease Study (ECCDS): results of drug treatment. Gastroenterology. 1984;86(2):249–66.

    PubMed  CAS  Google Scholar 

  71. Seidman EG, et al. Semi-elemental diet versus prednisone in pediatric Crohn’s disease. Gastroenterology. 1993;104:A778.

    Google Scholar 

  72. Seidman EG, et al. Elemental diet versus prednisone as initial therapy i Crohn’s disease: early and long-term results. Gastroenterology. 1991;100:150A.

    Google Scholar 

  73. Fernandez-Banares F, et al. How effective is enteral nutrition in inducing clinical remission in active Crohn’s disease? A meta-analysis of the randomized clinical trials. J Parenter Enteral Nutr. 1995;19:1056–64.

    Article  Google Scholar 

  74. Messori A, et al. Defined-formula diets versus steroids in the treatment of active Crohn’s disease. A meta-analyss. Scand J Gastroenterol. 1996;31:267–72.

    Article  PubMed  CAS  Google Scholar 

  75. Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007;1:CD000542.

    PubMed  Google Scholar 

  76. Borrelli O, et al. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol. 2006;4(6): 744–53.

    Article  PubMed  Google Scholar 

  77. Jadad AR, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.

    Article  PubMed  CAS  Google Scholar 

  78. Gonzalez-Huix F, et al. Polymeric enteral diets as primary treatment of active Crohn’s disease: a prospective steroid controlled trial. Gut. 1993;34(6):778–82.

    Article  PubMed  CAS  Google Scholar 

  79. Heuschkel RB, et al. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children. J Pediatr Gastroenterol Nutr. 2000;31(1):8–15.

    Article  PubMed  CAS  Google Scholar 

  80. Day AS, et al. Exclusive enteral feeding as primary therapy for Crohn’s disease in Australian children and adolescents: a feasible and effective approach. J Gastroenterol Hepatol. 2006;21(10): 1609–14.

    Article  PubMed  Google Scholar 

  81. Akobeng AK, Thomas AG. Enteral nutrition for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2007;3:CD005984.

    PubMed  Google Scholar 

  82. Verma S, Holdsworth CD, Giaffer MH. Does adjuvant nutritional support diminish steroid dependency in Crohn disease? Scand J Gastroenterol. 2001;36(4):383–8.

    Article  PubMed  CAS  Google Scholar 

  83. Takagi S, et al. Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Aliment Pharmacol Ther. 2006;24(9):1333–40.

    Article  PubMed  CAS  Google Scholar 

  84. Yamamoto T, et al. Enteral nutrition for the maintenance of remission in Crohn’s disease: a systematic review. Eur J Gastroenterol Hepatol. 2010;22(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  85. Verma S, et al. Oral nutritional supplementation is effective in the maintenance of remission in Crohn’s disease. Dig Liver Dis. 2000;32(9):769–74.

    Article  PubMed  CAS  Google Scholar 

  86. Yamamoto T, et al. Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn’s disease: a prospective study. Inflamm Bowel Dis. 2007;13(12):1493–501.

    Article  PubMed  Google Scholar 

  87. Yamamoto T, et al. Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: a prospective, non-randomized, parallel, controlled study. Aliment Pharmacol Ther. 2007;25(1):67–72.

    Article  PubMed  CAS  Google Scholar 

  88. Hirakawa H, et al. Home elemental enteral hyperalimentation (HEEH) for the maintenance of remission in patients with Crohn’s disease. Gastroenterol Jpn. 1993;28(3):379–84.

    PubMed  CAS  Google Scholar 

  89. Wilschanski M, et al. Supplementary enteral nutrition maintains remission in paediatric Crohn’s disease. Gut. 1996;38(4):543–8.

    Article  PubMed  CAS  Google Scholar 

  90. Esaki M, et al. Factors affecting recurrence in patients with Crohn’s disease under nutritional therapy. Dis Colon Rectum. 2006;49 Suppl 10:S68–74.

    Article  PubMed  Google Scholar 

  91. Ikeuchi H, et al. Efficacy of nutritional therapy for perforating and non-perforating Crohn’s disease. Hepatogastroenterology. 2004; 51(58):1050–2.

    PubMed  Google Scholar 

  92. Esaki M, et al. Preventive effect of nutritional therapy against postoperative recurrence of Crohn disease, with reference to findings determined by intra-operative enteroscopy. Scand J Gastroenterol. 2005;40(12):1431–7.

    Article  PubMed  Google Scholar 

  93. Bamba T, et al. Dietary fat attenuates the benefits of an elemental diet in active Crohn’s disease: a randomized, controlled trial. Eur J Gastroenterol Hepatol. 2003;15(2):151–7.

    Article  PubMed  CAS  Google Scholar 

  94. Belli DC, et al. Chronic intermittent elemental diet improves growth failure in children with Crohn’s disease. Gastroenterology. 1988;94(3):603–10.

    PubMed  CAS  Google Scholar 

  95. Tanaka T, et al. Effect of concurrent elemental diet on infliximab treatment for Crohn’s disease. J Gastroenterol Hepatol. 2006;21(7): 1143–9.

    Article  PubMed  CAS  Google Scholar 

  96. Yamamoto T, et al. Prospective clinical trial: enteral nutrition during maintenance infliximab in Crohn’s disease. J Gastroenterol. 2010;45(1):24–9.

    Article  PubMed  CAS  Google Scholar 

  97. Buchanan E, et al. The use of exclusive enteral nutrition for induction of remission in children with Crohn’s disease demonstrates that disease phenotype does not influence clinical remission. Aliment Pharmacol Ther. 2009;30(5):501–7.

    Article  PubMed  CAS  Google Scholar 

  98. Froslie KF, et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology. 2007;133(2):412–22.

    Article  PubMed  Google Scholar 

  99. Tibble JA, et al. Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease. Gastroenterology. 2000;119(1):15–22.

    Article  PubMed  CAS  Google Scholar 

  100. Modigliani R, et al. Clinical, biological, and endoscopic picture of attacks of Crohn’s disease. Evolution on prednisolone. Groupe d’Etude Therapeutique des Affections Inflammatoires Digestives. Gastroenterology. 1990;98(4):811–8.

    Article  PubMed  CAS  Google Scholar 

  101. Fell JME, et al. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease. Aliment Pharmacol Ther. 2000;14:281–9.

    Article  PubMed  CAS  Google Scholar 

  102. Berni Canani R, et al. Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn’s disease. Dig Liver Dis. 2006;38(6):381–7.

    Article  PubMed  CAS  Google Scholar 

  103. Yamamoto T, et al. Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis. 2005;11(6):580–8.

    Article  PubMed  Google Scholar 

  104. Breese EJ, et al. The effect of treatment on lymphokine-secreting cells in the intestinal mucosa of children with Crohn’s disease. Aliment Pharmacol Ther. 1995;9(5):547–52.

    Article  PubMed  CAS  Google Scholar 

  105. Breese EJ, et al. Tumor necrosis factor alpha-producing cells in the intestinal mucosa of children with inflammatory bowel disease. Gastroenterology. 1994;106(6):1455–66.

    PubMed  CAS  Google Scholar 

  106. Ferguson A, Glen M, Ghosh S. Crohn’s disease: nutrition and nutritional therapy. Baillieres Clin Gastroenterol. 1998;12(1):93–114.

    Article  PubMed  CAS  Google Scholar 

  107. Judd TA, et al. Update of fecal markers of inflammation in inflammatory bowel disease. J Gastroenterol Hepatol. 2011;26(10): 1493–9.

    Article  PubMed  CAS  Google Scholar 

  108. Gerasimidis K, et al. Serial fecal calprotectin changes in children with Crohn’s disease on treatment with exclusive enteral nutrition: associations with disease activity, treatment response, and prediction of a clinical relapse. J Clin Gastroenterol. 2011;45(3):234–9.

    Article  PubMed  Google Scholar 

  109. de Jong NS, Leach ST, Day AS. Fecal S100A12: a novel noninvasive marker in children with Crohn’s disease. Inflamm Bowel Dis. 2006;12(7):566–72.

    Article  PubMed  Google Scholar 

  110. Nahidi L, et al. Osteoprotegerin in pediatric Crohn’s disease and the effects of exclusive enteral nutrition. Inflamm Bowel Dis. 2011;17(2):516–23.

    Article  PubMed  Google Scholar 

  111. Bannerjee K, et al. Anti-inflammatory and growth-stimulating effects precede nutritional restitution during enteral feeding in Crohn disease. J Pediatr Gastroenterol Nutr. 2004;38(3):270–5.

    Article  PubMed  CAS  Google Scholar 

  112. Beattie RM, et al. Responsiveness of IGF-I and IGFBP-3 to therapeutic intervention in children and adolescents with Crohn’s disease. Clin Endocrinol (Oxf). 1998;49(4):483–9.

    Article  CAS  Google Scholar 

  113. Royall D, et al. Total enteral nutrition support improves body composition of patients with active Crohn’s disease. JPEN J Parenter Enteral Nutr. 1995;19(2):95–9.

    Article  PubMed  CAS  Google Scholar 

  114. Afzal NA, et al. Colonic Crohn’s disease in children does not respond well to treatment with enteral nutrition if the ileum is not involved. Dig Dis Sci. 2005;50(8):1471–5.

    Article  PubMed  Google Scholar 

  115. Newby EA, et al. Interventions for growth failure in childhood Crohn’s disease. Cochrane Database Syst Rev. 2005;3:CD003873.

    PubMed  Google Scholar 

  116. Whitten KE, et al. Effect of exclusive enteral nutrition on bone turnover in children with Crohn’s disease. J Gastroenterol. 2010;45(4):399–405.

    Article  PubMed  CAS  Google Scholar 

  117. Otley A, et al. The IMPACT questionnaire: a valid measure of health-related quality of life in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2002;35(4):557–63.

    Article  PubMed  Google Scholar 

  118. Gailhoustet L, et al. Study of psychological repercussions of 2 modes of treatment of adolescents with Crohn’s disease. Arch Pediatr. 2002;9(2):110–6.

    Article  PubMed  CAS  Google Scholar 

  119. Afzal NA, et al. Improvement in quality of life of children with acute Crohn’s disease does not parallel mucosal healing after treatment with exclusive enteral nutrition. Aliment Pharmacol Ther. 2004;20(2):167–72.

    Article  PubMed  CAS  Google Scholar 

  120. Hill R, et al. Quality of life in children with Crohn disease. J Pediatr Gastroenterol Nutr. 2010;51(1):35–40.

    Article  PubMed  Google Scholar 

  121. Kuriyama M, et al. Enteral nutrition improves health-related quality of life in Crohn’s disease patients with long disease duration. Hepatogastroenterology. 2009;56(90):321–7.

    PubMed  Google Scholar 

  122. Kuroki F, Matsumoto T, Iida M. Selenium is depleted in Crohn’s disease on enteral nutrition. Dig Dis. 2003;21(3):266–70.

    Article  PubMed  Google Scholar 

  123. Akobeng AK, et al. Effect of exclusive enteral nutritional treatment on plasma antioxidant concentrations in childhood Crohn’s disease. Clin Nutr. 2007;26(1):51–6.

    Article  PubMed  CAS  Google Scholar 

  124. Schatorje E, Hoekstra H. Transient hypertransaminasemia in paediatric patients with Crohn disease undergoing initial treatment with enteral nutrition. J Pediatr Gastroenterol Nutr. 2010;51(3): 336–40.

    PubMed  CAS  Google Scholar 

  125. Lemberg DA, Leach ST, Day AS. Transient hypertransaminasemia in pediatric patients with Crohn disease. J Pediatr Gastroenterol Nutr. 2011;53(2):229.

    Article  PubMed  CAS  Google Scholar 

  126. Afzal NA, et al. Refeeding syndrome with enteral nutrition in ­children: a case report, literature review and clinical guidelines. Clin Nutr. 2002;21(6):515–20.

    Article  PubMed  CAS  Google Scholar 

  127. Akobeng AK, Thomas AG. Refeeding syndrome following exclusive enteral nutritional treatment in Crohn disease. J Pediatr Gastroenterol Nutr. 2010;51(3):364–6.

    PubMed  Google Scholar 

  128. Seidman E. Relapse prevention/growth enhancement in pediatric Crohn’s disease: multicentre randomized controlled trial of intermittent enteral nutrition versus alternate day prednisone. J Pediatr Gastroenterol Nutr. 1996;23:A344.

    Article  Google Scholar 

  129. Knight C, et al. Long-term outcome of nutritional therapy in paediatric Crohn’s disease. Clin Nutr. 2005;24(5):775–9.

    Article  PubMed  CAS  Google Scholar 

  130. Rubio A, et al. The efficacy of exclusive nutritional therapy in paediatric Crohn’s disease, comparing fractionated oral vs. continuous enteral feeding. Aliment Pharmacol Ther. 2011;33(12): 1332–9.

    Article  PubMed  CAS  Google Scholar 

  131. Beattie RM, et al. Polymeric nutrition as the primary therapy in children with small bowel Crohn’s disease. Aliment Pharmacol Ther. 1994;8(6):609–15.

    Article  PubMed  CAS  Google Scholar 

  132. O’Sullivan MA, O’Morain CA. Nutritional therapy in Crohn’s disease. Inflamm Bowel Dis. 1998;4(1):45–53.

    Article  PubMed  Google Scholar 

  133. Akobeng AK, et al. Double-blind randomized controlled trial of glutamine-enriched polymeric diet in the treatment of active Crohn’s disease. J Pediatr Gastroenterol Nutr. 2000;30(1):78–84.

    Article  PubMed  CAS  Google Scholar 

  134. Gassull MA, et al. Fat composition may be a clue to explain the primary therapeutic effect of enteral nutrition in Crohn’s disease: results of a double blind randomised multicentre european trial. Gut. 2002;51(2):164–8.

    Article  PubMed  CAS  Google Scholar 

  135. Leiper K, et al. A randomised controlled trial of high versus low long chain triglyceride whole protein feed in active Crohn’s disease. Gut. 2001;49(6):790–4.

    Article  PubMed  CAS  Google Scholar 

  136. Sakurai T, et al. Short-term efficacy of enteral nutrition in the treatment of active crohn’s disease: a randomized, controlled trial comparing nutrient formulas. JPEN J Parenter Enteral Nutr. 2002;26(2):98–103.

    Article  PubMed  CAS  Google Scholar 

  137. Johnson T, et al. Treatment of active Crohn’s disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial. Gut. 2006;55(3):356–61.

    Article  PubMed  CAS  Google Scholar 

  138. Gupta K, et al. A novel enteral nutritional therapy protocol for the treatment of pediatric Crohn’s disease. JPGN. 2010;51 Suppl 2:E87.

    Google Scholar 

  139. Grogan J, et al. Enteral feeding therapy for newly diagnosed pediatric Crohn’s disease: a double-blind randomized controlled trial with two years follow-up. Inflamm Bowel Dis. 2012;18(2):246–53.

    Article  PubMed  Google Scholar 

  140. Whitten KE, et al. International survey of enteral nutrition protocols used in children with Crohn’s disease. J Dig Dis. 2012;13(2):107–12.

    Article  PubMed  Google Scholar 

  141. Otley A, et al. Primary enteral nutrition induces and maintains remission and reduces steroid exposure in a paediatric Crohn’s disease population. Gastroenterology. 2005;128(4 (Suppl 2)):W1053.

    Google Scholar 

  142. Riordan AM, et al. Treatment of active Crohn’s disease by exclusion diet: East Anglian multicentre controlled trial. Lancet. 1993;342(8880):1131–4.

    Article  PubMed  CAS  Google Scholar 

  143. Shergill-Bonner R, et al. Food reintroduction after exclusive enteral nutrition—a clinical experience. JPGN. 2007;44:E36.

    Google Scholar 

  144. Konno M, et al. Guidelines for the treatment of Crohn’s disease in children. Pediatr Int. 2006;48(3):349–52.

    Article  PubMed  CAS  Google Scholar 

  145. Lochs H, et al. ESPEN guidelines on enteral nutrition: gastroenterology. Clin Nutr. 2006;25(2):260–74.

    Article  PubMed  CAS  Google Scholar 

  146. Grafors JM, Casswall TH. Exclusive enteral nutrition in the treatment of children with Crohn’s disease in Sweden: a questionnaire survey. Acta Paediatr. 2011;100(7):1018–22.

    Article  PubMed  Google Scholar 

  147. Day AS, et al. Exclusive enteral nutrition for children with Crohn’s disease: use in Australia and attitudes of Australian paediatric gastroenterologists. J Paediatr Child Health. 2009;45(6):337–41.

    Article  PubMed  Google Scholar 

  148. Stewart M, Day AS, Otley A. Physician attitudes and practices of enteral nutrition as primary treatment of paediatric Crohn disease in North America. J Pediatr Gastroenterol Nutr. 2009;52(1): 38–42.

    Article  CAS  Google Scholar 

  149. Critch J, et al. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2012;54(2):298–305.

    Article  PubMed  Google Scholar 

  150. Ruemmele FM, et al. Nutrition as primary therapy in pediatric Crohn’s disease: fact or fantasy? J Pediatr. 2000;136(3):285–91.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology & Nutrition, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, NS, Canada, B3K 6R8

    Anthony Otley MD, MSc, FRCPC

  2. Department of Paediatrics, University of Otago, Christchurch, Canterbury, New Zealand

    Andrew S. Day MB, MD, ChB, FRACP, AGAF

  3. Peadiatrics Department, Christchurch Hospital, Christchurch, Canterbury, New Zealand

    Andrew S. Day MB, MD, ChB, FRACP, AGAF

  4. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, McMaster Children’s Hospita, 1200 Main St. West, Hamilton, ON, Canada, L8N 3Z5

    Mary Zachos MD, FRCPC

Authors
  1. Anthony Otley MD, MSc, FRCPC
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  2. Andrew S. Day MB, MD, ChB, FRACP, AGAF
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  3. Mary Zachos MD, FRCPC
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Corresponding author

Correspondence to Anthony Otley MD, MSc, FRCPC .

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Editors and Affiliations

  1. Perelman School of Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Petar Mamula

  2. School of Medicine--Greenville, Pediatric Gastroenterology & Nutrition, University of South Carolina, 200 Patewood Drive, Suite A-140, Greenville, 29615, South Carolina, USA

    Jonathan E. Markowitz

  3. Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, 34th St. & Civic Ctr. Blvd., Philadelphia, 19104, Pennsylvania, USA

    Robert N. Baldassano

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Otley, A., Day, A.S., Zachos, M. (2013). Nutritional Management of Inflammatory Bowel Disease. In: Mamula, P., Markowitz, J., Baldassano, R. (eds) Pediatric Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5061-0_28

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