Introduction Exclusive enteral nutrition (EEN) is the primary therapy for children with intestinal Crohn's disease (CD) in the UK. We hypothesised that entering remission with EEN predicted a longer duration of remission.
Methods Retrospective data were obtained on children with CD from 2003 to 2006 at a tertiary paediatric gastroenterology centre. Response was determined by Physicians Global Assessment. Outcome measures investigated were: relapse rates, time to relapse, corticosteroid (CS) use and treatment escalation. Relapse was defined as worsening symptoms and/or increase in CRP with a change in medication. p Values of <0.05 were considered significant.
Results 75 children with CD were diagnosed between 2003 and 2006, in whom 62 had 5 year follow-up data available. 56 patients (90.3%) received EEN upon diagnosis. The others received 5-ASA  or antibiotics , and were excluded from the analysis. No patients received corticosteroids as initial treatment. The median age [range] at diagnosis was 12.87 [4.84–15.86] years. 62.5%  of patients had ileo-colonic disease. 94.6% [53/56] of patients tolerated EEN. 57.1%  of patients went into clinical remission with EEN. Corticosteroids were prescribed to those who failed to enter remission with EEN. Multivariate analysis showed no correlation between disease location (p=0.70), ethnicity (p=0.43), age (p=0.25) or CRP (p=0.73) and response to EEN. All of the patients with colonic disease relapsed over 5 years (n=7), compared to 79% [11/14] of patients with ileal disease and 77% [27/35] of patients with ileo-colonic disease (p=0.37). The patients who responded to EEN remained in remission significantly longer than the non-responders. Median time to relapse [range] over the 5 years was 17.4 [4.23–49.32] months in responders vs 9.72 [2.87–47.6] months in non-responders; p=0.041 (Abstract PTU-131 figure 1). 50% [16/32] of patients who responded to EEN had no corticosteroid use over the 5 years. There was no significant difference in those starting azathioprine between responders and non-responders (75% [23/32] vs 87.5% [21/24]; p=0.20), or in rates of infliximab (22% [7/32] vs 37.5% [9/24], p=0.24) or surgery (28% [9/32] vs 37.5% [9/24], p=0.57).
Conclusion This is the first study proving that achievement of clinical remission with EEN predicts an improved outcome for paediatric patients with Crohn's disease over the next 5 years. It is possible that this is due to improved mucosal healing in children responding to EEN.
A.Rao and N.Kamperidis contributed equally and should be considered as joint first authors.
Competing interests None declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.