Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial

Tracey Johnson ¹, Sarah Macdonald ², Susan M Hill ², Adrian Thomas ³ and Michael Stephen Murphy ^1*

¹ Birmingham Children's Hospital NHS Trust, United Kingdom
² Great Ormond Street Hospital for Children, London, United Kingdom
³ Booth Hall Children's Hospital, Manchester, United Kingdom

^* To whom correspondence should be addressed. E-mail: m.s.murphy{at}bham.ac.uk.

Accepted 28 July 2005

Abstract

Background and aims: Total enteral nutrition with a liquid formula (TEN) can suppress gut inflammation and induce remission in active Crohn's disease. The mechanism is obscure. Studies have suggested that long- term nutritional supplementation (partial enteral nutrition, PEN) may also suppress inflammation and prevent relapse. Our aim was to compare PEN with conventional TEN in active Crohn's disease.

Patients and methods: Fifty children with a Paediatric Crohn's Disease Activity Index (PCDAI) > 20 were randomly assigned to receive 50% (PEN) or 100% (TEN) of their energy requirement as elemental formula for 6 weeks. The PEN group was encouraged to eat an unrestricted diet, while those receiving TEN were not allowed to eat. The primary outcome was achievement of remission (PCDAI<10). Secondary analyses of changes in ESR, CRP, albumin and platelets were performed to look for evidence of anti-inflammatory effects.

Results: The remission rate with PEN was lower than with TEN (15% versus 42%; p=0.035). Although the PCDAI fell in both groups (p=0.001 for both), the reduction was greater with TEN (p=0.005). Moreover, the fall in PCDAI with PEN was due to symptomatic and nutritional benefits. With both treatments there were significant improvements in relation to abdominal pain, 'sense of wellbeing' and nutritional status. However, only TEN led to a reduction in diarrhoea (p=0.02), an increase in haemoglobin and albumin, and a fall in platelets and ESR.

Conclusions: TEN suppresses inflammation in active Crohn's disease, but PEN does not. This suggests that long-term nutritional supplementation although beneficial to some patients, is unlikely to suppress inflammation and so prevent disease relapse.

Keywords: Crohn's disease, elemental diet, enteral nutrition

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