Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn's disease: Results from the GROWTH CD study

Noa Cohen-Dolev, Malgorata Sladek, Seamus Hussey, Dan Turner, G. Veres, Sibylle Koletzko, Javier Martin de Carpi, Annamaria Staiano, Ron Shaoul, Paolo Lionetti, Jorge Amil Dias, Anders Paerregaard, Federica Nuti, Tamar Pfeffer Gik, Tomer Ziv-Baran, Sivan Ben Avraham Shulman, Chen Sarbagili Shabat, Rotem Sigall Boneh, Richard K. Russell, Arie Levinea

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. Methods: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. Results: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.

Original languageEnglish
Pages (from-to)306-312
Number of pages7
JournalJournal of Crohn's and Colitis
Volume12
Issue number3
DOIs
Publication statusPublished - Jan 1 2018

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Enteral Nutrition
Crohn Disease
Steroids
Adrenal Cortex Hormones
Propensity Score
Recurrence
Growth

Keywords

  • Child
  • Complications
  • Crohn
  • Diet
  • Enteral nutrition
  • Growth
  • Inflammatory bowel disease
  • Relapse
  • Steroids

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn's disease : Results from the GROWTH CD study. / Cohen-Dolev, Noa; Sladek, Malgorata; Hussey, Seamus; Turner, Dan; Veres, G.; Koletzko, Sibylle; de Carpi, Javier Martin; Staiano, Annamaria; Shaoul, Ron; Lionetti, Paolo; Dias, Jorge Amil; Paerregaard, Anders; Nuti, Federica; Gik, Tamar Pfeffer; Ziv-Baran, Tomer; Shulman, Sivan Ben Avraham; Shabat, Chen Sarbagili; Boneh, Rotem Sigall; Russell, Richard K.; Levinea, Arie.

In: Journal of Crohn's and Colitis, Vol. 12, No. 3, 01.01.2018, p. 306-312.

Research output: Contribution to journalArticle

Cohen-Dolev, N, Sladek, M, Hussey, S, Turner, D, Veres, G, Koletzko, S, de Carpi, JM, Staiano, A, Shaoul, R, Lionetti, P, Dias, JA, Paerregaard, A, Nuti, F, Gik, TP, Ziv-Baran, T, Shulman, SBA, Shabat, CS, Boneh, RS, Russell, RK & Levinea, A 2018, 'Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn's disease: Results from the GROWTH CD study', Journal of Crohn's and Colitis, vol. 12, no. 3, pp. 306-312. https://doi.org/10.1093/ecco-jcc/jjx150
Cohen-Dolev, Noa ; Sladek, Malgorata ; Hussey, Seamus ; Turner, Dan ; Veres, G. ; Koletzko, Sibylle ; de Carpi, Javier Martin ; Staiano, Annamaria ; Shaoul, Ron ; Lionetti, Paolo ; Dias, Jorge Amil ; Paerregaard, Anders ; Nuti, Federica ; Gik, Tamar Pfeffer ; Ziv-Baran, Tomer ; Shulman, Sivan Ben Avraham ; Shabat, Chen Sarbagili ; Boneh, Rotem Sigall ; Russell, Richard K. ; Levinea, Arie. / Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn's disease : Results from the GROWTH CD study. In: Journal of Crohn's and Colitis. 2018 ; Vol. 12, No. 3. pp. 306-312.
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abstract = "Background: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. Methods: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. Results: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7{\%} of CS [12/87] versus 11.6{\%} of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47{\%}] in CS and 38/60 [63{\%}] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.",
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T1 - Differences in outcomes over time with exclusive enteral nutrition compared with steroids in children with mild to moderate Crohn's disease

T2 - Results from the GROWTH CD study

AU - Cohen-Dolev, Noa

AU - Sladek, Malgorata

AU - Hussey, Seamus

AU - Turner, Dan

AU - Veres, G.

AU - Koletzko, Sibylle

AU - de Carpi, Javier Martin

AU - Staiano, Annamaria

AU - Shaoul, Ron

AU - Lionetti, Paolo

AU - Dias, Jorge Amil

AU - Paerregaard, Anders

AU - Nuti, Federica

AU - Gik, Tamar Pfeffer

AU - Ziv-Baran, Tomer

AU - Shulman, Sivan Ben Avraham

AU - Shabat, Chen Sarbagili

AU - Boneh, Rotem Sigall

AU - Russell, Richard K.

AU - Levinea, Arie

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. Methods: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. Results: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.

AB - Background: Exclusive enteral nutrition [EEN] and corticosteroids [CS] induce similar rates of remission in mild to moderate paediatric Crohn's disease [CD], but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long-term outcomes. Methods: We prospectively followed newly diagnosed children aged < 17 years, with mild to moderate CD at baseline, for 2 years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications [fibrostenotic disease, penetrating disease, and active perianal disease] and growth were recorded throughout the study. A propensity score analysis was performed. Results: A total of 147 children [mean age 12.9 ± 3.2 years], treated by EEN [n = 60] or CS [n = 87] were included. New complications developed in 13.7% of CS [12/87] versus 11.6% of EEN [7/60], p = 0.29. Remission was achieved in 41/87 [47%] in CS and 38/60 [63%] EEN, p = 0.036. Median time to relapse did not differ [14.4 ± 1 months with CS, 16.05 ± 1.1 EEN, p = 0.28]. Mean height Z scores decreased from Week 0 to Week 78 with CS [-0.34 ± 1.1 to -0.51 ± 1.2, p = 0.01], but not with EEN [-0.32 ± 1.1 to -0.22 ± 0.9, p = 0.56]. In a propensity score analysis, EEN was superior to CS for inducing remission [p = 0.05] and trended to superiority for height Z score [p = 0.055]. Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but with similar relapse and complication rates in new-onset mild to moderate paediatric CD.

KW - Child

KW - Complications

KW - Crohn

KW - Diet

KW - Enteral nutrition

KW - Growth

KW - Inflammatory bowel disease

KW - Relapse

KW - Steroids

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