Inflammatory Bowel Diseases

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Inflammatory Bowel Diseases:
doi: 10.1002/ibd.21690
Original Article: Original Clinical Articles

Enteral Feeding Therapy for Newly Diagnosed Pediatric Crohn's Disease: A Double‐Blind Randomized Controlled Trial with Two Years Follow‐Up§

Grogan, Joanne L. BSc, SRD1; Casson, David H. BA, MRCPI2; Terry, Allyson BSc, SRD1; Burdge, Graham C. PhD3; El‐Matary, Wael MD, MSc, FRCPCH2; Dalzell, Mark A. BSc, MBBS, FRCPCH2*

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Background:: This study compared the efficacy of an elemental formula (EF) to a polymeric formula (PF) in inducing remission for pediatric Crohn's disease (CD).

Methods:: Newly diagnosed CD children were randomized to EF or PF for 6 weeks. Change in the Pediatric Crohn's Disease Activity Index (PCDAI), fecal calprotectin, and plasma fatty acids were measured at 0 and 6 weeks. Patients were followed up for 2 years. Time and treatment choice for first relapse were documented.

Results:: Thirty‐four children completed the study; EF: 15 (7 M, 8 F), PF: 19 (13 M, 6 F). The mean age was (years) EF: 12.6, PF: 11.7. Ninety‐three percent of children (14/15) achieved remission in the EF group and 79% (15/19) in the PF group. One‐third of patients maintained remission for 2 years. Mean time to relapse (days); EF: 183 (63–286), PF: 162 (53–301). Most children who relapsed used feed as a treatment for that relapse (EF: 9/10 and PF: 8/13). With PF, an increase of eicosapentanoic acid (EPA) and alpha linolenic acid was found with a reciprocal decrease in arachidonic acid (AA). With EF, AA and EPA levels were reduced with a significant decrease in docosahexaenoic acid. Fecal calprotectin measurements decreased significantly but did not normalize at the end of week 6.

Conclusions:: There was no significant difference between EF and PF in inducing remission. One‐third of children maintained remission. Changes in plasma polyunsaturated fatty acid status were subtle and may be relevant; however, further evaluation is recommended. (Inflamm Bowel Dis 2011;)

© Crohn's & Colitis Foundation of America, Inc.

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