Exclusive enteral nutrition practices in the management of Crohn's disease: A cross sectional survey of specialist paediatric dietitians.

Abstract

Exclusive enteral nutrition (EEN) is the first line management to induce remission of active Crohn's disease (CD). EEN is well established but there continues to be significant variation in practice especially in relation to what first line formula is used, length of time on EEN, and food reintroduction. The survey aimed to establish dietetic practices in implementing EEN in the management of active CD across specialist paediatric inflammatory bowel disease (IBD) centres. An online, cross-sectional survey was developed, piloted, and distributed to dietitians working at tertiary paediatric IBD centres. Centres were identified through a member of the British Society of Paediatric Gastroenterology, Hepatology, and Nutrition (BSPGHAN) working group. All 20 specialist IBD centres within the United Kingdom were approached and invited to complete the survey. Eighty-five percent (17/20) of the specialist IBD centres in the UK responded. 100% of centres used polymeric feeds as their first line and 70% (12/17) of centres recommended EEN for 6 weeks. Dietetic monitoring whilst on EEN over the 6-8 weeks varied significantly, ranging from 30% (5/17) of centres monitored weekly compared with 30% of centres (5/17) only if clinical need indicated. There was a wide range in practices regarding which foods and drinks were permitted whilst on EEN. Forty three percent (7/17) introduced solid foods over five to seven days, 19% (3/17) introduced food over seven to 14 days and 38% (6/17) introduced food over a minimum of 14 days. Eighteen percent (3/17) of centres were offering the Crohn's disease exclusion diet as a treatment for IBD. Despite available evidenced based guidelines there is still considerable variation in the management of EEN to induce remission in active CD especially in relation to frequency of dietetic review and foods permitted during and after EEN. Further research is required to understand the impact this may have on achieving and maintaining remission in CD.