Exclusive enteral nutrition is effective and feasible as primary induction and re-induction therapy in Asian children with Crohn's disease

• Main Authors: Chan, Kok Joo, Song, Zhi Liang, Chew, Kee Seang, Ng, Ruey Terng, Mohd Taib, Siti Hawa, Lee, Way Seah
• Format: Article
• Published: Wiley 2021
• Subjects: R Medicine; RJ Pediatrics
• Online Access: http://eprints.um.edu.my/28361/
• Institution: Universiti Malaya

Aim We aimed to ascertain the efficacy and feasibility of exclusive enteral nutrition (EEN) as an induction and re-induction therapy in Asian children with Crohn's disease (CD). Methods All children diagnosed with CD between 1995 and 2019 were reviewed. Response to induction was compared between EEN and standard immunosuppression (IS) using Paediatric Crohn's Disease Activity Index, growth failure, perianal disease and extra-intestinal manifestations. Two study groups were analysed: (i) primary induction and (ii) re-induction for relapses. Results Twenty-nine children (mean age (+/- standard deviation) at diagnosis 9.4 +/- 8.5 years old, ileo-colonic 35%, non-stricturing 79%) were studied. At primary induction (group 1;n= 18), no difference was observed in remission rates (9/13 vs.5/5;P= 0.278), efficacy for improving growth failure (6/8 vs.0/1;P> 0.999), perianal disease (4/6 vs.0/2;P> 0.999) and extra-intestinal manifestations (2/2 vs.0/0;P> 0.999) with EEN or standard IS. Group 2 (n= 38 relapses), no difference was observed in remission rates (16/19 vs.15/19,P> 0.999), growth failure (0/7 vs.4/14;P =0.328), perianal disease (1/10 vs.7/7;P> 0.999) and extra-intestinal manifestations (0/0 vs.1/1;P> 0.999) with EEN or standard IS. Both treatment modalities were equally effective as re-induction in relapses in patients previously treated with EEN (P =0.191). Conclusion As compared to standard IS, EEN was equally effective in primary induction and re-induction for relapse in Asian children with CD and can be repeatedly used for recurrent relapses.