Long-term outcome of nutritional therapy in paediatric Crohnʹs disease

Background & Aims Long-term effects of using enteral feed therapy to induce remission in paediatric Crohnʹs disease are poorly documented. The aim of this study is to examine the short and long-term impact of enteral nutrition as primary therapy for children with newly diagnosed Crohnʹs disease. Methods Since 1994, a data base was set up in Bristol for all children with inflammatory bowel diseases. The data of newly diagnosed patients with Crohnʹs disease in whom enteral nutrition was used as the primary therapy (44 children) was analysed, with particular reference to time to remission, to first and subsequent relapse, and to first steroid usage. Results Forty out of 44 patients (90%) responded to enteral nutrition, with a median time to remission of 6 weeks. 25 of these 40 (62%) relapsed, with a median duration of remission of 54.5 weeks (range 4–312). 15 (38%) have not relapsed. 21 of the 44 (47%) have not received steroids. In those who eventually required steroids, their use was postponed for a median 68 weeks (range 6–190). Site of disease activity had no impact on response to enteral nutrition, but there was a trend towards earlier relapse in those with isolated colonic involvement. Conclusions This data suggests that there are long-term benefits to the use of enteral nutrition to induce remission in children with Crohnʹs disease Steroids may be avoided in nearly half the cases and, in others, their use postponed by 68 weeks.