Journal
ALIMENTARY PHARMACOLOGY & THERAPEUTICS
Volume 37, Issue 6, Pages 622-629Publisher
WILEY
DOI: 10.1111/apt.12230
Keywords
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Funding
- NHS research Scotland fellowship
- MSD Immunology
- Abbott
- Dr Falk Pharmaceutical
- Nestle Pharmaceutical
- Ferring Pharmaceutical
- Nestle
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Background Exclusive enteral nutrition (EEN) is an effective first line treatment for active paediatric Crohn's disease (CD). Aim To examine the effect of EEN on short- and long-term clinical outcome together with anthropometric measurements. Methods Retrospective case-note review in newly diagnosed CD (<16years) who completed 8weeks of EEN. Demographics, anthropometry, disease characteristics and inflammatory markers were collected at EEN initiation and at 1, 2, 6, 12 & 24months post treatment initiation. EEN response was determined by a patient global assessment. Results One hundred and nine patients were included (Males 68; Median age: 11.2years). After 8weeks EEN, 65 were in remission, 32 improved and 12 had no improvement. By 4weeks, mean weight/BMI z-score (s.d.) increased (P<0.02) and between 4 and 8weeks (P<0.05). Baseline inflammatory markers all improved significantly by week 4 (albumin, CRP and platelets; all P<0.01) and ESR (P<0.00001). 63/109(58%) relapsed during follow-up. 44/63(70%) patients completed a second course of EEN with similar response rate, but lower weight gain (3.3 vs. 5.1kg, P<0.05). Height z-score did not change significantly over the 24months. Introduction of azathioprine within 6months of diagnosis did not improve height outcomes at 24months. Conclusions Weight and BMI z-score improved with EEN and changes are sustained to 2years, but height z-score did not. Seventy per cent of patients who relapsed during 2-year follow-up managed a 2nd course of EEN. The optimal therapeutic strategies for length of EEN course and to improve linear growth are awaited.
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