Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal Crohn's disease

Grover, Z., Burgess, C., Muir, R., Reilly, C. and Lewindon, P. J. (2016) Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal Crohn's disease. Journal of Crohn's and Colitis, 10 10: 1159-1164. doi:10.1093/ecco-jcc/jjw075


Author Grover, Z.
Burgess, C.
Muir, R.
Reilly, C.
Lewindon, P. J.
Title Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal Crohn's disease
Journal name Journal of Crohn's and Colitis   Check publisher's open access policy
ISSN 1873-9946
1876-4479
Publication date 2016-10-01
Sub-type Article (original research)
DOI 10.1093/ecco-jcc/jjw075
Open Access Status Not yet assessed
Volume 10
Issue 10
Start page 1159
End page 1164
Total pages 6
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2017
Language eng
Formatted abstract
Background: Exclusive Enteral Nutrition (EEN) induction in children with luminal Crohn’s disease (CD) gives early mucosal healing (MH), but the long-term benefits of EEN-induced MH are just emerging.

Aims & Methods:
We prospectively followed an Australian cohort of newly diagnosed children with predominantly luminal CD who completed at least six weeks EEN and with paired clinical Pediatric Crohn’s Disease Activity Index (PCDAI), biochemical (C-reactive protein; CRP) and endoscopic assessment at diagnosis and post EEN. All commenced immunomodulators (IMs) early (<3 months from diagnosis) and had a minimum of 1 year follow-up. Complete MH was a simple endoscopic score for Crohn’s disease (SES-CD) of 0, and SES-CD≥1 was ascribed to active endoscopic disease (aED) and further divided into near complete MH (SES 1–3), mild active disease (SES-CD 4–10) and moderate to severe disease (SES-CD>10). The primary outcome was long-term supervised sustained remission (SR) on IMs alone without need for corticosteroids, infliximab (IFX) or surgery.

Results:
A total of 54 eligible children (33 males) completing EEN induction were analysed. The median duration between pre and post EEN assessments was 60.5 days [interquartile range (IQR), 56–69.5]. Post EEN: clinical remission (PCDAI < 10) was observed in 45/54 (83%), and biochemical remission (PCDAI < 10 and CRP < 5 mg/dl) was observed in 39/54 (72%). Complete MH was observed in 18/54 (33%), near complete in 10/54(19%). SR was superior in those with complete MH vs. aED; 13/18, (72%) vs. 10/36 (28%), p = 0.003 at 1 year, 8/16, (50%) vs. 3/24, (8%), p = 0.008 at 2 years and (8/16, (50%) vs. 1/19, (6%), p = 0.005) at 3 years. Near-complete MH did not lead to superior SR.

Conclusions:
Only complete MH post EEN induction predicts more favourable SR for up to 3 years.
Keyword EEN
Mucosal healing
Simple endoscopic score for CD
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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