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Systematic review with meta‐analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease
Author(s) -
Swaminath A.,
Feathers A.,
Ananthakrishnan A. N.,
Falzon L.,
Li Ferry S.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.14253
Subject(s) - medicine , parenteral nutrition , crohn's disease , enteral administration , calprotectin , meta analysis , population , adverse effect , disease , gastroenterology , inflammatory bowel disease , pediatrics , environmental health
Background Despite potential adverse‐events in a paediatric population, corticosteroids are used to induce remission in paediatric Crohn's disease. Exclusive enteral nutrition also induces remission, but is infrequently used in the USA because corticosteroids are considered the superior therapy. New data have become available since the publication of the most recent meta‐analysis in 2007. Aim To see if current literature supports the use of EEN versus CS in paediatric populations. Methods All studies with comparator arms of exclusive enteral nutrition and an exclusive corticosteroids, with remission clearly defined were identified by searching eight online databases. Results Of 2795 identified sources, nine studies met our inclusion criteria. Eight of these (n = 451), had data that could be abstracted into our meta‐analysis. Exclusive enteral nutrition was as effective as corticosteroids in inducing remission ( OR = 1.26 [95% CI 0.77, 2.05]) in paediatric Crohn's disease. There was no difference between Exclusive enteral nutrition and corticosteroids efficacy when comparing newly diagnosed Crohn's ( OR = 1.61 [95% CI .87, 2.98]) or relapsed ( OR = 0.76 [95% CI .29‐1.98]). Intestinal healing was significantly more likely among patients receiving Exclusive enteral nutrition compared to corticosteroids ( OR = 4.5 [95% CI 1.64, 12.32]). There was no difference in the frequency of biomarker normalisation including CRP ( OR = 0.85 [95% CI .44, 1.67]) and faecal calprotectin ( OR 2.79 [95% CI .79‐10.90]). Conclusions There is no difference in efficacy between exclusive enteral nutrition and corticosteroids in induction of remission in Crohn's disease in a paediatric population. Exploratory analyses suggest that a greater proportion of patients treated with exclusive enteral nutrition achieved mucosal healing.