Oral nutritional therapy as effective as enteral for pediatric Crohn’s
MedWire News: Fractionated oral nutritional therapy is as effective as continuous enteral administration for treating children with Crohn's disease (CD), suggest study findings.
"Oral intake of a solid-free diet for 8 weeks on an exclusive basis is a real alternative to rather aggressive enteral therapy via tube feeding to induce remission in children with CD," say Frank Ruemmele (Necker-Enfants Malades Hospital, Paris, France) and co-authors.
Using medical records from the Necker-Enfants Malades hospital, the team identified 106 children aged on average 11 years with active CD who were treated using exclusive enteral nutrition (EEN) by oral route or via continuous nasogastric tube feeding between 2004 and 2010.
In total, 72% of patients were newly diagnosed with CD, and all presented with moderate-to-severe disease activity (Pediatric Crohn's Disease Activity Index [PCDAI] score >30) at baseline. The two groups did not differ significantly in terms of anthopometric data, disease severity, inflammatory parameters, and associated treatment.
Following 8 weeks of EEN, 75% and 85% of patients achieved remission with oral and enteral nutrition, respectively. Patients receiving enteral nutrition had a significantly longer hospital stay compared with those on exclusive oral nutrition, at 4.4 versus 2.2 days, respectively.
All patients showed a significant decrease in disease severity and a significant improvement in anthropometric measures and inflammatory serum indices. Improvements were comparable between groups at week 8, except for weight gain, which was significantly higher for patients on continuous enteral feeding, compared with fractionated oral therapy (5.9 vs 4.6 kg).
When the researchers evaluated adherence rates in the two groups, no significant difference was found in the amount of Modulen IBD taken throughout the study period. However, 13% and 10% of patients in the oral and enteral groups, respectively, did not fully comply with treatment.
Follow-up endoscopy revealed complete mucosal healing of all ulcerative or erosive lesions in seven of eight patients treated with oral therapy at week 8, compared with five of eight patients treated with continuous enteral nutrition. Furthermore, all patients with mucosal healing achieved complete clinical remission.
"Appropriate prospective clinical trials are needed to confirm these findings," conclude the researchers in the journal Alimentary Pharmacology and Therapeutics.
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By Ingrid Grasmo