Exclusive Enteral Nutrition: Clinical Effects and Changes in Mucosal Cytokine Profile in Pediatric New Inflammatory Bowel Disease.

Helena Rolandsdotter,Kerstin Jönsson-Videsäter,Michael Eberhardson,Ulrika L Fagerberg,Yigael Finkel

doi:10.3390/nu11020414

Abstract

Exclusive Enteral Nutrition (EEN) is the first-line treatment in children with Crohn’s disease (CD) for induction of remission. However, the mode of action remains conjectural. The aim of this study was to investigate whether the effect of EEN is paralleled by changes in the mucosal cytokine profiles (MCP). Twelve children with new onset inflammatory bowel disease (IBD) received induction treatment with a polymeric EEN. We assessed clinical, endoscopic and histologic scoring before and after EEN. Twelve colonic cytokines were analyzed by Polymerase Chain Reaction (PCR) in six of the IBD patients at onset and after EEN as well as in six non-IBD control children at the diagnostic colonoscopy. Twelve children completed 6 weeks of EEN, except from one child who completed 4 weeks. At the control colonoscopy, 83% were in complete clinical remission. Changes were found in the MCPs of individual patients after EEN. In particular, children with IBD showed significantly higher values of Interleukin (IL)-12β (p = 0.008) and IL-23α (p = 0.02) compared to non-IBD controls at the diagnostic colonoscopy. Furthermore, an overall change in proinflammatory cytokines was noted in the IBD-group after treatment. Further studies are warranted to understand the role of EEN in MCP.

Highlights

Crohn’s disease (CD) and Ulcerative Colitis (UC), the major entities of pediatric inflammatory bowel disease (IBD), are chronic inflammatory conditions of the gastrointestinal tract
Thirteen children were included with a CD diagnosis according to the ECCO/ESPGHAN
We aimed to investigate the effect of Enteral Nutrition (EEN) treatment on symptoms, biochemistry, endoscopy, histopathology and mucosal cytokine profile in children with new onset IBD

Summary

Introduction

Crohn’s disease (CD) and Ulcerative Colitis (UC), the major entities of pediatric IBD, are chronic inflammatory conditions of the gastrointestinal tract. Childhood IBD is characterized by more severe symptoms and wider disease extension at diagnosis compared to adults [1]. Nausea and bloody diarrhea are common symptoms in both children and adults while growth retardation is frequently seen in pediatric patients [2]. EEN is the first-line treatment for remission induction of CD. Nutrients 2019, 11, 414 in pediatric patients. The clinical remission rate is 73–80% and it effectively induces mucosal healing (MH) at a rate that is superior to corticosteroids [3,4,5,6,7]. EEN is recommended to all children with luminal disease, including those with colonic involvement [3]

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