TY - JOUR
T1 - Differences in outcomes over time with exclusive enteral nutrition compared to steroids in children with mild to moderate Crohn's Disease
T2 - results from the GROWTH CD study
AU - Cohen-Dolev, Noa
AU - Sladek, Malgorata
AU - Hussey, Seamus
AU - Turner, Dan
AU - Veres, Gabor
AU - Koletzko, Sibylle
AU - Martin de Carpi, Javier
AU - Staiano, Annamaria
AU - Shaoul, Ron
AU - Lionetti, Paolo
AU - Amil Dias, Jorge
AU - Paerregaard, Anders
AU - Nuti, Federica
AU - Pfeffer Gik, Tamar
AU - Ziv-Baran, Tomer
AU - Ben Avraham Shulman, Sivan
AU - Sarbagili Shabat, Chen
AU - Sigall Boneh, Rotem
AU - Russell, Richard K
AU - Levine, Arie
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Exclusive enteral nutrition (EEN) and corticosteroids (CS) both induce similar rates of remission in mild to moderate pediatric Crohn's disease (CD), but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long term outcomes.Methods: We prospectively followed newly diagnosed children <17 years with mild to moderate disease at baseline for two years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications (fibrostenotic, penetrating disease, and active perianal disease) and growth were recorded throughout the study. A propensity score analysis was performed.Results: 147 children (mean age 12.9±3.2 years), treated by EEN (n=60) or CS (n=87) were included. New complications developed in 13.7% of CS (12/87) versus 11.6% of EEN (7/60), p=0.29. Remission was achieved in 41/87 (47%) in CS and 38/60 (63%) EEN, p=0.036. Median time to relapse did not differ (14.4±1 months with CS, 16.05±1.1 EEN, p=0.28). Mean height Z scores decreased from week 0 to week 78 with CS (-0.34±1.1 to -0.51±1.2, p=0.01), but not with EEN (-0.32± 1.1 to -0.22± 0.9 p=0.56). In a propensity score analysis, EEN was superior to CS for inducing remission (p=0.05) and trended to superiority for height Z score (p=0.055).Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but similar relapse and complication rates in new onset mild to moderate paediatric CD.
AB - Background: Exclusive enteral nutrition (EEN) and corticosteroids (CS) both induce similar rates of remission in mild to moderate pediatric Crohn's disease (CD), but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long term outcomes.Methods: We prospectively followed newly diagnosed children <17 years with mild to moderate disease at baseline for two years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications (fibrostenotic, penetrating disease, and active perianal disease) and growth were recorded throughout the study. A propensity score analysis was performed.Results: 147 children (mean age 12.9±3.2 years), treated by EEN (n=60) or CS (n=87) were included. New complications developed in 13.7% of CS (12/87) versus 11.6% of EEN (7/60), p=0.29. Remission was achieved in 41/87 (47%) in CS and 38/60 (63%) EEN, p=0.036. Median time to relapse did not differ (14.4±1 months with CS, 16.05±1.1 EEN, p=0.28). Mean height Z scores decreased from week 0 to week 78 with CS (-0.34±1.1 to -0.51±1.2, p=0.01), but not with EEN (-0.32± 1.1 to -0.22± 0.9 p=0.56). In a propensity score analysis, EEN was superior to CS for inducing remission (p=0.05) and trended to superiority for height Z score (p=0.055).Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but similar relapse and complication rates in new onset mild to moderate paediatric CD.
KW - Journal Article
U2 - 10.1093/ecco-jcc/jjx150
DO - 10.1093/ecco-jcc/jjx150
M3 - Journal article
C2 - 29165666
SN - 1873-9946
VL - 12
SP - 306
EP - 312
JO - Journal of Crohn's & colitis
JF - Journal of Crohn's & colitis
IS - 3
ER -