Format

Send to

Choose Destination
Aliment Pharmacol Ther. 2017 Oct;46(7):645-656. doi: 10.1111/apt.14253. Epub 2017 Aug 16.

Systematic review with meta-analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease.

Author information

1
Division of Gastroenterology, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
2
Division of Gastroenterology, Massachusetts General Hospital, Cambridge, MA, USA.
3
Columbia University Medical Center, New York, NY, USA.
4
Teachers College, Columbia University, New York, NY, USA.

Abstract

BACKGROUND:

Despite potential adverse-events in a paediatric population, corticosteroids are used to induce remission in paediatric Crohn's disease. Exclusive enteral nutrition also induces remission, but is infrequently used in the USA because corticosteroids are considered the superior therapy. New data have become available since the publication of the most recent meta-analysis in 2007.

AIM:

To see if current literature supports the use of EEN versus CS in paediatric populations.

METHODS:

All studies with comparator arms of exclusive enteral nutrition and an exclusive corticosteroids, with remission clearly defined were identified by searching eight online databases.

RESULTS:

Of 2795 identified sources, nine studies met our inclusion criteria. Eight of these (n = 451), had data that could be abstracted into our meta-analysis. Exclusive enteral nutrition was as effective as corticosteroids in inducing remission (OR = 1.26 [95% CI 0.77, 2.05]) in paediatric Crohn's disease. There was no difference between Exclusive enteral nutrition and corticosteroids efficacy when comparing newly diagnosed Crohn's (OR = 1.61 [95% CI .87, 2.98]) or relapsed (OR = 0.76 [95% CI .29-1.98]). Intestinal healing was significantly more likely among patients receiving Exclusive enteral nutrition compared to corticosteroids (OR = 4.5 [95% CI 1.64, 12.32]). There was no difference in the frequency of biomarker normalisation including CRP (OR = 0.85 [95% CI .44, 1.67]) and faecal calprotectin (OR 2.79 [95% CI .79-10.90]).

CONCLUSIONS:

There is no difference in efficacy between exclusive enteral nutrition and corticosteroids in induction of remission in Crohn's disease in a paediatric population. Exploratory analyses suggest that a greater proportion of patients treated with exclusive enteral nutrition achieved mucosal healing.

PMID:
28815649
PMCID:
PMC5798240
DOI:
10.1111/apt.14253
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center