Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn's disease: Results from the GROWTH CD study

Noa Cohen-Dolev, Malgorata Sladek, Seamus Hussey, Dan Turner, Gabor Veres, Sibylle Koletzko, Javier Martin de Carpi, Annamaria Staiano, Ron Shaoul, Paolo Lionetti, Jorge Amil Dias, Anders Paerregaard, Federica Nuti, Tamar Pfeffer Gik, Tomer Ziv-Baran, Sivan Ben Avraham Shulman, Chen Sarbagili Shabat, Rotem Sigall Boneh, Richard K. Russell, Arie Levinea*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

70 Scopus citations

Abstract

Background: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. Methods: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. Results: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.

Original languageAmerican English
Pages (from-to)306-312
Number of pages7
JournalJournal of Crohn's and Colitis
Volume12
Issue number3
DOIs
StatePublished - 28 Feb 2018

Bibliographical note

Publisher Copyright:
© 2016 European Crohn's and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved.

Keywords

  • Child
  • Complications
  • Crohn
  • Diet
  • Enteral nutrition
  • Growth
  • Inflammatory bowel disease
  • Relapse
  • Steroids

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