scholarly journals Short-Term Efficacy of Exclusive Enteral Nutrition in Pediatric Crohn’s Disease: Practice in China

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Youyou Luo ◽  
Jindan Yu ◽  
Hong Zhao ◽  
Jingan Lou ◽  
Feibo Chen ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Effects ◽  
Enteral Nutrition ◽  
Activity Index ◽  
Remission Rate ◽  
Disease Activity Index ◽  
Laboratory Findings ◽  
Exclusive Enteral Nutrition ◽  
Steroid Group

Aims. The objective of this study was to compare the efficacy of exclusive enteral nutrition (EEN) and corticosteroids in inducing remission in pediatric Crohn’s disease (CD) and the effects of the treatment on growth improvements.Methods. Data was retrospectively collected for children and adolescents newly diagnosed with CD in a referral center. Patients who were followed up for more than 2 months with mild to moderate disease were included. Basic demographics, history, physical examination, the pediatric Crohn disease activity index (PCDAI), laboratory findings, endoscopic findings, and adverse effects were recorded. Remission was defined as PCDAI < 10 points.Results. Ten subjects received EEN and 18 patients received corticosteroids. The median follow-up in EEN group and steroid group was 9.2 weeks and 9.6 weeks, respectively. The remission rate in EEN group was significantly higher than that in steroid group (90.0% versus 50.0%, resp.,P<0.05). Growth improvement, which was evaluated by changes in height for agez-score, was more apparent in EEN group than that in steroids groupP<0.05. No adverse effects were observed in EEN group.Conclusions. In children with mild to moderate CD, EEN is more effective than corticosteroids in improving disease severity and growth deficiency, as well as providing less side effects.

scholarly journals Exclusive Enteral Nutrition versus Infliximab in Inducing Therapy of Pediatric Crohn’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Youyou Luo ◽  
Jindan Yu ◽  
Jingan Lou ◽  
Youhong Fang ◽  
Jie Chen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Effects ◽  
Enteral Nutrition ◽  
Clinical Symptoms ◽  
Activity Index ◽  
Group Versus ◽  
Disease Activity Index ◽  
Mucosal Healing ◽  
Exclusive Enteral Nutrition

Aim. To compare the effectiveness of exclusive enteral nutrition (EEN) and infliximab (IFX) therapy in pediatric Crohn’s disease (CD). Methods. In a prospective study of children initiating EEN or infliximab therapy for CD, we compared clinical outcomes using the pediatric Crohn’s disease activity index (PCDAI), growth improvement, endoscopic mucosal healing, and adverse effects. Data were measured at baseline and after 8 weeks of therapy. Results. We enrolled 26 children with CD; of whom, 13 were treated with infliximab, 13 with EEN. Clinical response (PCDAI) reduction ≥ 15 or final PCDAI ≤ 10 was achieved by 83.3% in the EEN group and 90.9% in the IFX group. Body mass index for age (BMIFA) z-scores were significantly increased in both groups (P<0.05). No significant differences were observed in PCDAI, height for age (HFA), or BMI recovery between two groups. Adverse effects were detected in 30.7% on infliximab and 0% on EEN. Mucosal healing was achieved in 71.4% cases in the EEN group versus 85.7% in the IFX group. Conclusion. EEN provided similar improvements as IFX in clinical symptoms, mucosal healing, and BMI. EEN therapy has less adverse effects when compared with IFX. This trial is registered with the Clinical Registration Number: ChiCTR-OON-17010834.

scholarly journals Use of Exclusive Enteral Formula Diet as Adjunctive Therapy for Treatment of a Crohn’s Disease Flare

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Levi M Teigen ◽  
Abigail J Johnson ◽  
Eugenia Shmidt ◽  
Byron P Vaughn
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Activity Index ◽  
Disease Activity Index ◽  
Formula Diet ◽  
Disease Flare ◽  
Exclusive Enteral Nutrition ◽  
Activity Index Score ◽  
Enteral Formula

Abstract Introduction We report the case of an adult patient who achieved remission of a Crohn’s disease flare after treatment with exclusive enteral nutrition as adjunctive therapy to medication. Case Report A 46-year-old man with severe, stricturing Crohn’s presented for severe abdominal pain and weight loss; estimated Crohn’s Disease Activity Index score greater than 300. Antibiotics, vedolizumab, budesonide, and exclusive enteral nutrition diet were instituted. Approximately 30 days later, his Crohn’s Disease Activity Index score improved to 170. Discussion This case illustrates the possible utility of an exclusive enteral formula diet as an adjunct to medication to induce remission of a Crohn’s disease flare.

scholarly journals Maintenance of Remission with Partial Enteral Nutrition Therapy in Pediatric Crohn’s Disease: A Retrospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Jacqueline M. Schulman ◽  
Liat Pritzker ◽  
Ron Shaoul
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Activity Index ◽  
Disease Activity Index ◽  
Physician Global Assessment ◽  
Clinical Relapse ◽  
Exclusive Enteral Nutrition ◽  
Maintenance Of Remission ◽  
Concomitant Medications

Background. Partial enteral nutrition (PEN) may be helpful for the maintenance of remission in pediatric Crohn’s disease patients. Aims. To evaluate the efficacy of PEN treatment for preventing clinical relapse. Methods. We retrospectively assessed 42 pediatric Crohn’s disease patients who entered clinical remission on 4–12 weeks of exclusive enteral nutrition (EEN) and were maintained on PEN as a supplementary diet. We evaluated the efficacy of the treatment at different time points using the weighted Pediatric Crohn Disease Activity Index (wPCDAI), Physician Global Assessment, laboratory parameters, and growth of each patient. Additionally, we assessed the use of concomitant medications. Results. The median length of remission with PEN was 6 (0–36) months. Patients’ remission was maintained on PEN without concomitant medications for a median time of zero months (0–16). The mean body mass index in the PEN group increased from 18.1 to 18.8 after six months of PEN. The median wPCDAI decreased from 30 at diagnosis to 5.0 after EEN and increased to 7.5 after three months of PEN. Overall, the median wPCDAI decreased by 26.2. Conclusions. PEN treatment was partially effective in maintaining remission and was able to increase BMI and lower wPCDAI. Most patients required concomitant medication after PEN initiation.

scholarly journals Effectiveness of Crohn’s Disease Exclusion Diet for Induction of Remission in Crohn’s Disease Adult Patients

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4112
Author(s):  
Martyna Szczubełek ◽  
Karolina Pomorska ◽  
Monika Korólczyk-Kowalczyk ◽  
Konrad Lewandowski ◽  
Magdalena Kaniewska ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Activity Index ◽  
Disease Activity Index ◽  
Paediatric Population ◽  
Adult Patients ◽  
Exclusive Enteral Nutrition ◽  
Inflammatory Bowel ◽  
Exclusion Diet

Exclusive enteral nutrition (EEN) is a first-line treatment in active, mild to moderate Crohn’s disease (CD) in children. The Crohn’s disease exclusion diet (CDED), which avoids products known to have a pro-inflammatory effect on the intestinal mucosa, presents similar effectiveness to EEN for inducing remission in the paediatric population. The aim of the study was to evaluate the effectiveness of the CDED in inducing remission in adult patients. Between March 2020 and May 2021, 32 patients in a gastroenterology outpatient centre were treated according to the assumptions of the CDED. The patients were seen at baseline, at week 6, and at week 12 of the study. During the visits, anthropometric measurements and laboratory tests were performed, Crohn’s disease activity index (CDAI) was calculated, and the Inflammatory Bowel Disease Questionnaire (IBDQ) was completed. The study included a total of 32 participants, 18 women (56.3%) and 14 men (43.7%). Clinical remission was obtained in 76.7% patients after 6 weeks and in 82.1% after 12 weeks of therapy. Calprotectin levels were significantly lower in the second follow-up compared with baseline (p = 0.021). The CDED is an effective therapy for inducing remission in the adult CD population.

scholarly journals Induction of Remission in Pediatric Crohn’s Disease Patients Assessed by the Mucosal Inflammation Noninvasive Index

2021 ◽  
Vol 10 (23) ◽  
pp. 5613
Author(s):  
Roma Herman ◽  
Paulina Dumnicka ◽  
Stanisław Pieczarkowski ◽  
Krzysztof Fyderek
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Induction Therapy ◽  
Activity Index ◽  
Disease Activity Index ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
Mucosal Inflammation ◽  
Exclusive Enteral Nutrition

Mucosal healing (MH) is the main therapeutic goal of Crohn’s disease (CD). The Mucosal Inflammation Noninvasive Index (MINI) appears to be a promising tool for distinguishing MH from its inflammation. This study aims to evaluate MINI in monitoring remissions induced by exclusive enteral nutrition (EEN) in pediatric CD patients. Out of 55 newly diagnosed CD children, 31 who completed 6–8 weeks of EEN were analyzed. Clinical and biochemical data, activity of CD assessed with the Pediatric Crohn’s Disease Activity Index (PCDAI) and MINI were compared within seven days pre- and post-EEN. Response to induction therapy was defined as a decrease of PCDAI by >12.5 points. The follow-up was performed up to 12 months after EEN termination. Out of 31 children who completed 6–8 weeks of EEN, eight required corticosteroids in addition to EEN. Twenty-four patients (77%) responded to induction therapy. In responders, MINI decreased from 19 (Q1:17; Q3:22) to 12 (Q1:6; Q3:14), p < 0.001. The diagnostic accuracy of post-EEN MINI and post-EEN fecal calprotectin (FC) for treatment failure were AUC: 0.899 (95%CI: 0.737–1.000) and 0.762 (95%CI: 0.570–0.954), respectively. In the follow-up of 25 patients (80.6%), the post-EEN MINI of ≥13 points predicted CD relapse (87.5% sensitivity; 64.7% specificity), while FC had no prognostic value. MINI allows for monitoring of EEN and is superior in predicting disease relapse to FC.

scholarly journals Exclusive enteral nutrition for induction of remission in anti-tumor necrosis factor refractory adult Crohn’s disease: the Indian experience

2020 ◽  
Vol 18 (2) ◽  
pp. 184-191 ◽  
Author(s):  
Ajit Sood ◽  
Arshdeep Singh ◽  
Ritu Sudhakar ◽  
Vandana Midha ◽  
Ramit Mahajan ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Tumor Necrosis Factor ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Clinical Remission ◽  
Tumor Necrosis ◽  
Activity Index ◽  
Exclusive Enteral Nutrition ◽  
Number Of Patients ◽  
Necrosis Factor

Background/Aims: Exclusive enteral nutrition (EEN) is recommended for induction of remission in pediatric Crohn’s disease (CD). However, it is not currently recommended for inducing remission in adults. This report describes the use of 12-week EEN for induction of remission in anti-tumor necrosis factor (anti-TNF) refractory adult CD.Methods: This is a retrospective analysis of adults with moderate to severe active (Crohn’s Disease Activity Index [CDAI] >220) anti-TNF refractory CD, who received EEN for 12 weeks between April 2018 and March 2019 at Dayanand Medical College and Hospital, Ludhiana, India. Primary outcomes included achievement of clinical remission and fistula healing at 12 weeks. Improvement in inflammatory markers and nutritional status were the secondary end points.Results: Out of 23 patients who received anti-TNF agents, 7 (30.4%) were refractory and were offered EEN as a salvage therapy. Six patients (66.7% females, mean age 25.6±6.5 years) consented. Four patients (66.6%) achieved clinical remission (CDAI <150). Mean CDAI of patients decreased significantly after 12 weeks of EEN (388.8±74.8 vs. 160.0±25.2, <i>P</i><0.001). Perianal fistulas showed clinical response (drainage decreased by >50%), though none achieved remission. Entero-enteric fistulae showed complete healing. Mean body mass index improved from 15.6±3.1 to 18.9±1.9 kg/m<sup>2</sup> at week 12 (<i>P</i>=0.003). Hemoglobin and serum albumin also improved from 8.2±1.1 g/dL and 2.8±0.3 g/dL at baseline to 12.6±0.6 g/dL and 3.6±0.5 g/dL post-EEN respectively (<i>P</i><0.001 and <i>P</i>=0.006 respectively).Conclusions: EEN appears to be an effective and well tolerated therapy for induction of remission in anti-TNF refractory adult CD. More data from prospective trials with larger number of patients is required.

Efficacy and Safety of Thalidomide in Crohn’s Disease Patients with Perianal Fistula and Abscess

2021 ◽  
Author(s):  
Zhenyi Tian ◽  
Lingying Ning ◽  
Rui Feng ◽  
Shu Xu ◽  
Baili Chen ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Effects ◽  
Disease Activity ◽  
Activity Index ◽  
Perianal Fistula ◽  
Perianal Abscess ◽  
Disease Activity Index ◽  
Abscess Drainage ◽  
Thalidomide Treatment

Abstract Background Medical therapies of parianal Crohn’s disease (CD) are limited. Thalidomide is an effective medical therapy to alleviate disease activity of CD. However, the effects and safety of thalidomide in the treatment of perianal fistula and abscess was not evaluated. Methods This retrospective cohort study was performed at a tertiary referral centre and recruited 73 patients with perianal CD who received thalidomide (50–100 mg) daily for 1 year. Data collected included demographics, medications, and disease behaviour. Clinical assessment of CD was conducted using the Crohn’s Disease Activity Index (CDAI), and perianal lesions were evaluated using the Fistula Drainage Assessment index and Perianal Disease Activity Index (PDAI). At the same time, the occurrence of adverse effects was recorded during treatment. Wilcoxon's signed-rank test and Student’s t-test were used to analyse the data. Results The CDAI score and laboratory indices were significantly lower after thalidomide treatment than at baseline (all P < 0.01). The value of PDAI was significantly lower in patients with symptomatic perianal abscess after thalidomide treatment than at baseline (10 [6.25, 10] versus 2.5 [1, 3.75]; P = 0.05). PDAI was also significantly reduced in all patients treated with thalidomide whether with or without perianal abscess drainage (all P < 0.05). The rates of responsive patients were similar between the thalidomide group and thalidomide combined with azathioprine group (72.73% [8/11] and 84% [21/25], respectively; P = 0.65). In total, 31% (24/77) of patients experienced adverse events, and interventions were required in 15 patients to reduce or eliminate discomfort from adverse events. Four patients discontinued thalidomide due to adverse effects. Side effects (rash, diarrhoea, peripheral neuropathy, somnolence, constipation, and numbness) were mild and mostly transient. Conclusions Thalidomide is effective in inducing clinical remission and response in CD patients with perianal fistula and abscess with or without abscess drainage. Thalidomide in combination with azathioprine is also effective in these patients. Low-dose thalidomide is proven to be effective and safe in treating perianal CD patients.

scholarly journals OP16 Characterization of the Clinical Features and Outcomes of Paediatric Patients with Isolated Colonic Crohn’s Disease: A Multi-center Study from the Porto Group of ESPGHAN

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S015-S016
Author(s):  
T Berger ◽  
H Miin Lee ◽  
L Ramasamy Padmanaban ◽  
E Wine ◽  
A Yerushalmi ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Features ◽  
Activity Index ◽  
Disease Activity Index ◽  
Exclusive Enteral Nutrition ◽  
Protein Levels ◽  
Paediatric Patients ◽  
L1 And L2

Abstract Background Isolated colonic (L2) Crohn’s disease (CD) in adults is thought to have unique clinical and genetic features compared with ileal (L1) CD and ulcerative colitis (UC). Similar studies in paediatrics are scarce. Our goal was to characterize the clinical features of paediatric patients with isolated colonic CD and compare them to patients with ileo-cecal CD and those with UC. Methods This was a multi-center retrospective study including 21 sites affiliated with the Porto IBD group and IBD interest group of ESPGHAN. Data of paediatric patients diagnosed between 2014–2017 with L1 or L2 CD, or with UC, was collected, including information on demographic, clinical and laboratory parameters at diagnosis, end of induction, 1 year and 3 years after diagnosis (or at last follow-up). Results Data was collected on 300 children (102 L1, 94 L2, 104 UC) with similar demographic features. At diagnosis, bloody stools were identified in 45% of L2 patients, compared with 15% and 95% of L1 and UC patients, respectively (P&lt;0.001), while fever was documented in 27% of L2 patients, compared to 13% and 3% of L1 and UC patients, respectively (P&lt;0.001). At the time of diagnosis, the median pediatric Crohn’s disease activity index for patients with L1 and L2 was 25 (IQR 17.5–37) and 27.5 (20–40), respectively, while the median pediatric ulcerative colitis activity index was 40 (30–55) for patients with UC. C-reactive protein levels were significantly higher among CD patients (both L1 and L2), compared to patients with UC, and calprotectin values were comparable. ASCA was positive in 55%, 25% and 2% (P&lt;0.001) and pANCA in 2%, 17% and 53% (P&lt;0.001) in L1, L2 and UC patients, respectively. Granulomas were identified in 36% of L2 patients, similar to patients with L1 (33%). For induction therapy, exclusive enteral nutrition, oral steroids and mesalazine were used in 50%, 45% and 38% of patients with L2 CD, compared with 72%, 28% and 9%, and 0%, 52% and 75% of L1 and UC patients, respectively (P&lt;0.001). Steroid-free clinical remission at the end of induction was overall similar between groups, around 55%. At 1-year post-diagnosis, 62%, 68% and 40% were on an immunomodulator (P=0.03) and 41%, 26% and 22% were receiving anti-TNFα agent (P=0.01), of patients with L1, L2 and UC, respectively. While time to initiation of an anti-TNFα agent was significantly shorter in L1 patients compared with L2 and UC (P=0.03), time to admission and time to surgery were similar. Conclusion Paediatric patients with isolated colonic CD exhibit several clinical features which differentiate them from ileo-cecal CD and UC. Prospective studies are required to understand the pathogenesis of this unique entity and define short- and long-term outcomes.

scholarly journals Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP

Nutrients ◽  
2020 ◽  
Vol 12 (4) ◽  
pp. 1012
Author(s):  
Melinda Moriczi ◽  
Gemma Pujol-Muncunill ◽  
Rafael Martín-Masot ◽  
Santiago Jiménez Treviño ◽  
Oscar Segarra Cantón ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Disease Activity ◽  
Clinical Remission ◽  
Activity Index ◽  
Newly Diagnosed ◽  
Faecal Calprotectin ◽  
Exclusive Enteral Nutrition ◽  
Paediatric Crohn’S Disease

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.

scholarly journals Exclusive Enteral Nutrition Promotes Clinical Remission and Mucosal Healing of Southern China Pediatric Crohn’s Disease in Short Time

2021 ◽  
Author(s):  
Liya Xiong ◽  
Peiyu Chen ◽  
Jing Xie ◽  
Lu Ren ◽  
Hongli Wang ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Clinical Remission ◽  
Southern China ◽  
Remission Rate ◽  
Mucosal Healing ◽  
Exclusive Enteral Nutrition ◽  
First Line Therapy ◽  
Short Time

Abstract Background: this study aimed to understand the effective of exclusive enteral nutrition on clinical remission and mucosal healing with pediatric Crohn’s disease (CD)in a real-world setting in southern China. Methods: In this prospective disease registry, children (aged between 2 and 18years)with newly diagnosed luminal CD were recruited from December 2018 to December 2020. Patients were examined at baseline and at weeks3 and 8 of EEN induction. Logistic regression analysis is used to assess the influencing factors of EEN. Results: The clinical remission and mucosal healing rate of children is 76.5%、35% separately after 8 week induction. The remission rate of mild CD is higher than that of moderate-severe CD, but it is not statistically significant(p=0.01). Disease location、age、the response rate at week 3 all do not predict the effectiveness of EEN treatment.Conclusions: EEN can effectively promote clinical remission and mucosal healing of southern China pediatric Crohn’s disease in short time and is also recommend as the first-line therapy for children with severe luminal CD

Sign in / Sign up

Export Citation Format

Share Document