Abstract
BackgroundA limited body of research suggests that ongoing maintenance enteral nutrition (MEN) can be beneficial in maintaining disease remission in Crohn’s Disease (CD). We aimed to assess how achievable MEN is and whether it helps to prolong remission.MethodsPatients newly diagnosed with CD in 2010 and 2011 who commenced exclusive enteral nutrition (EEN) for 8 weeks were followed up for a year post diagnosis. All patients who took EEN were encouraged to continue MEN post EEN. Data on azathioprine use was also collected. Categorical variables were compared using chi–square/Fischer’s exact test. Medians were expressed along with complete data ranges.Results59 patients (34 male, median age 11.07 years, range 2.5-16.33 years) were identified. 11/59 (18%) had a poor response to EEN and were switched to steroids. 48/59 patients completed 8 weeks EEN and achieved clinical remission/response. 46/48 patients received Modulen IBD®, 29/48 (60%) consumed EEN orally and 19/48 (40%) via NGT. 15/48 (31%) patients were able to continue MEN post EEN completion. MEN was consumed for a mean of 10.8 months (range 4–14 months). 14/15 patients drank MEN and 1/15 had MEN via NGT. Remission rates at 1 year in patients continuing MEN were 60% (9/15) compared to15% (2/13) in patients taking no treatment (p = 0.001) and 65% (13/20) in patients taking azathioprine (p = 0.14).ConclusionA sub group of patients can continue MEN as a maintenance treatment and this seems a useful strategy, especially in those who are not commencing azathioprine.
Highlights
A limited body of research suggests that ongoing maintenance enteral nutrition (MEN) can be beneficial in maintaining disease remission in Crohn’s Disease (CD)
Nutritional therapy was first introduced as a treatment for CD in the 1970’s, [3] and since enteral nutrition (EEN) has been recognised in many centres as a first line treatment for active paediatric CD [4,5,6,7]
This study summarises the use of MEN in paediatric CD patients from a complete treatment cohort who have all received EEN for induction of remission
Summary
A limited body of research suggests that ongoing maintenance enteral nutrition (MEN) can be beneficial in maintaining disease remission in Crohn’s Disease (CD). Crohn’s disease (CD) is characterised by patchy, transmural inflammation, which may affect any part of the gastro-intestinal tract from the mouth to the anus. It is a lifelong condition with periods of remission or relapse. The aims of treatment include relief of symptoms, resumption of normal growth and pubertal development, prevention of relapse and complications as well as improvement in quality of life. EEN has been shown to improve nutritional complications at diagnosis including weight loss, improving inflammatory markers and promoting mucosal healing [8]
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