This study compared the efficacy of an elemental formula (EF) to a polymeric formula (PF) in inducing remission for pediatric Crohn's disease (CD).
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.
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.
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;)
1Dietetic Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
2Gastroenterology and Nutrition Unit, and Alder Hey Children's NHS Foundation Trust, Liverpool, UK
3Institute of Human Nutrition, University of Southampton, Southampton, UK
*Consultant Paediatric Gastroenterologist, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP. UK
Received 3 November 2010; Accepted 19 January 2011
Published online 18 March 2011 in Wiley Online Library (wileyonlinelibrary.com).
§Funded by a grant from SHS International Limited, Liverpool, UK.AMD and WEM are to be considered Joint senior authors.