Annual Meeting Of The European Society Of Pediatric Gastroenterology And Nutrition Thessaloniki, May 21-24, 1997
Improved nutritional state, “bowel rest” and the decreased antigenicity of elemental diets may facilitate healing of intestinal inflammation and thus permit normal growth and development in pediatric Crohn's disease (CD). Aim: To assess growth velocity and relapse frequency in children with quiescent CD and growth failure treated with a semi-elemental diet. Methods: At their choice, 20 CD patients (13±3.2 y) were treated orally (n=10) or via NG tube (n=10) with a flavoured semi-elemental diet (Peptamen ®) exclusively during 28 days every fourth month, over a one year period. The control CD group (11.4±2 y) received conventional medications, and a high calorie diet, as tolerated. All patients studied had to be 7-18 years old, and Tanner stage ≤III. Their ileal, ileocolonic or colonic CD had to be in remission (CDAI < 150) for at least six weeks prior to study entry, with growth data available for ≥ 6 months. The dose of prednisone had to be < 0.35 mg/kg every other day. Patients were excluded if an excision of a diseased bowel segment occured within 1 yr before study entry. Results: CDAI was assessed monthly, growth data and inflammatory parameters every 4 months, and are expressed as median (interquartile). Table
Patients in the control group were younger, and had not reached the same degree of growth delay compared to the dietary group, although disease duration was similar (11.5 and 9.5 mo., respectively). After 1 year, the total number of relapses for the diet group was significantly less than the controls (2 vs 8. p=0.03). Conclusions: Cyclical exclusive semi-elemental diet significantly reduced relapse frequency and permitted normalization of growth velocity and bone density in quiescent pediatric Crohn's disease with severe growth failure.