Enteral feeding therapy for newly diagnosed pediatric crohn's disease: A double‐blind randomized controlled trial with two years follow‐up

• Published in: Inflammatory bowel diseases 2012-02, Vol.18 (2), p.246-253
• Main Authors: Grogan, Joanne L., Casson, David H., Terry, Allyson, Burdge, Graham C., El‐Matary, Wael, Dalzell, A. Mark
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Crohn Disease - diagnosis; Crohn Disease - therapy; Crohn's disease; Double-Blind Method; Enteral Nutrition - methods; fatty acids; Fatty Acids - blood; Feces - chemistry; feed; Female; Follow-Up Studies; Food, Formulated; Humans; Leukocyte L1 Antigen Complex - analysis; Male; pediatric; Recurrence; Severity of Illness Index; Treatment Outcome
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.21690

Background: This study compared the efficacy of an elemental formula (EF) to a polymeric formula (PF) in inducing remission for pediatric Crohn's disease (CD). Methods: Newly diagnosed CD children were randomized to EF or PF for 6 weeks. Change in the Pediatric Crohn's Disease Activity Index (PCDAI), fecal calprotectin, and plasma fatty acids were measured at 0 and 6 weeks. Patients were followed up for 2 years. Time and treatment choice for first relapse were documented. Results: Thirty‐four children completed the study; EF: 15 (7 M, 8 F), PF: 19 (13 M, 6 F). The mean age was (years) EF: 12.6, PF: 11.7. Ninety‐three percent of children (14/15) achieved remission in the EF group and 79% (15/19) in the PF group. One‐third of patients maintained remission for 2 years. Mean time to relapse (days); EF: 183 (63–286), PF: 162 (53–301). Most children who relapsed used feed as a treatment for that relapse (EF: 9/10 and PF: 8/13). With PF, an increase of eicosapentanoic acid (EPA) and alpha linolenic acid was found with a reciprocal decrease in arachidonic acid (AA). With EF, AA and EPA levels were reduced with a significant decrease in docosahexaenoic acid. Fecal calprotectin measurements decreased significantly but did not normalize at the end of week 6. Conclusions: There was no significant difference between EF and PF in inducing remission. One‐third of children maintained remission. Changes in plasma polyunsaturated fatty acid status were subtle and may be relevant; however, further evaluation is recommended. (Inflamm Bowel Dis 2011;)