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