Exclusive Enteral Nutrition (EEN) is the first line treatment for the induction of remission in Paediatric Crohn’s Disease (CD).^{1 2} There are no studies which evaluate the effectiveness of one polymeric formula over another in terms of rates of remission.^{1 2} Our centre, prescribes feeds based on age, weight, taste preference, convenience, and allergic history.The aim of this retrospective chart review is to evaluate our local remission rates for paediatric Crohn’s disease patients having EEN and assess if standard polymeric feeds result in remission rates that are concurrent with published data. We retrospectively reviewed EEN patients between the 1st of November 2019 to 31st October 2022. The wPCDAI was calculated at baseline and at the end of treatment (6 weeks). Remission was defined as wPCDAI of below 12.5³; clinical response was defined as a reduction of more than 17.5 in wPCDAI (3). Fifty patients (30 Male and 20 Female, age range: 2y to 17y) were treated with EEN. 15/50 patients were excluded from the final cohort: 4/50 did not complete the prescribed course of EEN; 5/50 had incomplete clinical data (wPCDAI could not be calculated), 6/50 patients had EEN in combination with biologic treatment. 25/35 (71%) were in clinical remission following completion of EEN at 6 weeks. Furthermore, 29/35 (83%) had a clinical response to the treatment. Of the 25 patients who entered remission, 18 received standard polymeric sip feeds (Ensure plus/Paediasure Plus/Paediasure). 6/35 patients did not achieve clinical remission, however demonstrated a clinical response (minimum reduction of 17.5 in wPCDAI), with an average reduction of 36 in 6 weeks. Our remission rates (71%) were concurrent with published data. Standard polymeric remission rates were 70% at 6 weeks, which is comparable to oral Modulen IBD® (76%) at 8 weeks.⁴ This shows that standard feeds are effective for inducing remission in CD. It’s likely that increased feed choice may improve adherence to EEN. Furthermore, many publications evaluate the remission rates of EEN after 8 weeks.⁴ In future it may be beneficial for our centre to aim for a minimum of 8 weeks as some of the wPCDAI scores were just above the range that demonstrated clinical remission. Furthermore, including faecal calprotectin results at baseline and end of treatment may provide further insight regarding clinical remission.

References

1. Miele E, Shamir R, Aloir M. Nutrition in PIBD: A position paper on behalf of the porto IBD group of ESPGHAN. J Pediatr Gastroenterology Nutr. 2018 Apr.

2. Van Rheenen PF, Aloi M, Assa A. The medical management of paediatric crohn’s disease: an ECCO-ESPGHAN guideline update. J of Crohns Colitis 2022.

3. Turner D, Levine A, Walters TD. Which PCDAI version best reflects intestinal inflammation in pediatric crohn disease? JPGN 2017;(64)2.

4. Rubio A, Pigneur B, Garnier-Lengline H. The efficacy of exclusive nutritional therapy in paediatric crohn’s disease, comparing oral vs. continuous enteral feeding. Aliment Pharmacol Ther 2011;33(12):1332–9.