Exclusive enteral nutrition was as effective as corticosteroids for inducing remission in pediatric Crohn’s disease, according to a new meta-analysis.
The data further suggest that exclusive enteral nutrition may be even better than steroids for healing the intestinal mucosa in children with Crohn’s.
“Corticosteroids are the most commonly used medication to induce remission in the USA, but can pose particular risks in a pediatric population including: growth retardation, low bone mineral density, adrenal suppression and body image dissatisfaction,” Arun Swaminath, MD, of the division of gastroenterology at Lenox Hill Hospital, Northwell Health, New York City, and colleagues wrote. “As an alternative, gastroenterologists sometimes elect to use exclusive enteral nutrition (EEN) as induction therapy in these patients because adverse effects of enteral nutrition are generally limited to gastrointestinal tolerability (eg, nausea, vomiting, diarrhea) though rare reports of refeeding syndrome exist.”
EEN is frequently used in Europe, but less than 4% of pediatric gastroenterologists use it in North America, although its use appears to be increasing in Canada, the investigators noted.
As new data have become available in the 10 years since a previous meta-analysis was published on the subject, Swaminath and colleagues reviewed medical literature comparing EEN with corticosteroids in children with Crohn’s disease, and ultimately included eight studies totaling 451 patients in their meta-analysis.
The data showed that EEN was just as effective as corticosteroids for inducing remission (OR = 1.26; 95% CI, 0.77-2.05) whether patients were newly diagnosed (OR = 1.61; 95% CI, 0.87-2.98) or relapsing (OR = 0.76; 95% CI, 0.29-1.98).
Notably, the investigators found that patients who received EEN were more than four times as likely to experience mucosal healing than those treated with corticosteroids (OR = 4.5; 95% CI, 1.64-12.32).
Finally, the researchers noted they found no differences in how often biomarkers, including C-reactive protein and fecal calprotectin, normalized in patients treated with either therapy.
“The most common question in a newly diagnosed patient is ‘what should I eat?’ with the idea that they are motivated to make the necessary changes to get control of their Crohn’s,” Swaminath said in a press release. “This would be an ideal time to discuss this treatment option, especially in pediatric populations, but it does require a motivated patient and a supportive team — typically composed of a dietician, nurse, and physician, and often, family/peer supporters — to make it all happen.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.