ENTERAL NUTRITION FOR INDETERMINATE COLITIS. A NOVEL APPROACH

Abstract

46 Enteral nutrition is a well established treatment for acute Crohn's disease, but not ulcerative colitis. A whole casein, polymeric diet, which is both palatable and side-effect free has been shown to be highly effective at inducing a remission in children with active Crohn's disease 1. Indeterminate colitis is an inflammatory bowel disease in which histological features are not diagnostic for either Crohn's disease or ulcerative colitis. Patients are unlikely to be diagnosed as Crohn's disease in follow-up 2. The treatment for this group of children has traditionally been steroids and aminosalicylates. Aims: We describe 9 patients with indeterminate colitis who have been successfully treated with enteral nutrition. Methods: All patients received a 6-8 week course of whole casein, polymeric diet (CT3211 or AL110, Nestlé Clinical Nutrition). Only one patient required nasogastric tube feeding. 3 patients had colonoscopic biopsies taken before and after treatment. The degree of terminal ileal lymphonodular hyperplasia was endoscopically graded as marked, moderate, mild or normal. Biopsies were reviewed in a blinded manner by a histopathologist (SD). Clinical improvement was scored with a previously validated colitis symptom score. Results: In all nine patients there was a significant improvement in colitis symptom score after treatment. The patients biopsied showed an improvement in extent and severity of colonic inflammation. Conclusion: Enteral nutrition has a definite role in the treatment of acute indeterminate colitis.