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Enteral nutrition, corticosteroids equally effective in paediatric Crohn’s disease

04 Oct 2017

Exclusive enteral nutrition is as good as corticosteroids in terms of inducing remission in paediatric patients with Crohn’s disease, according to a study.

Researchers performed a systematic review and meta-analysis of eight studies involving 451 patients aged <18 years who had newly diagnosed or relapsed active Crohn’s disease. The studies were either randomized controlled trials or observational in nature, with at least two comparator arms including at least one dietary intervention administered by any route and one nondietary intervention.

Pooled data revealed that exclusive enteral nutrition was comparable in efficacy to corticosteroids in inducing remission (odds ratio [OR], 1.26; 95 percent CI, 0.77 to 2.05) in paediatric Crohn's disease. Results were consistent across patient subgroups of newly diagnosed (OR, 1.61; 0.87 to 2.98) or relapsed Crohn’s disease (OR, 0.76; 0.29 to 1.98).

However, the odds of intestinal healing were significantly greater among patients receiving exclusive enteral nutrition than among those on corticosteroids (OR, 4.5; 1.64 to 12.32).

No significant between-group difference was seen in the frequency of biomarker normalization, including C-reactive protein (OR, 0.85; 0.44 to 1.67) and faecal calprotectin (OR, 2.79; 0.79 to 10.90).

The findings show that exclusive enteral nutrition could potentially be superior to corticosteroids when assessing improvement by mucosal healing endpoints, researchers said.

“[Exclusive enteral nutrition] may have the added benefit of minimizing growth failure, avoiding undesirable and difficult to reverse changes to body habitus, and can potentially result in a deeper and longer duration of remission. As such, greater advocacy for this therapy … may be warranted,” they added.

Current clinical guidelines regard enteral nutrition as acceptable to use in all patients with Crohn’s disease. However, the mechanism of action of enteral nutrition remains unclear, and there is little guidance regarding which types of patients would be most likely to benefit.  [J Pediatr Gastroenterol Nutr 2012;54:298-305]

Furthermore, the challenge of considering induction treatment and the best approach to maintaining remission has yet to be overcome, given that using exclusive enteral nutrition in the long term may be unacceptable to most patients, researchers said.

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Most Read Articles
Elvira Manzano, 4 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
Yesterday
Breast cancer patients have notably different microbiomes in the local breast tissue and urinary tract, a recent study reveals. Particularly, species in the Methylobacterium genus are reduced in the local breast tissue while the urinary tract is enriched in gram-positive bacteria.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.
Tristan Manalac, Yesterday
Statin use, particularly in smokers, obese patients and nondiabetics, has a strong and dose-dependent association with decreasing risk of pancreatic ductal adenocarcinoma (PDAC), according to a new study.