Clinical progress in the two years following a course of exclusive enteral nutrition in 109 paediatric patients with Crohn's disease

Background Exclusive enteral nutrition (EEN) is an effective first line treatment for active paediatric Crohn's disease (CD). Aim To examine the effect of EEN on short- and long-term clinical outcome together with anthropometric measurements. Methods Retrospective case-note review in newly diagnosed CD (<16years) who completed 8weeks of EEN. Demographics, anthropometry, disease characteristics and inflammatory markers were collected at EEN initiation and at 1, 2, 6, 12 & 24months post treatment initiation. EEN response was determined by a patient global assessment. Results One hundred and nine patients were included (Males 68; Median age: 11.2years). After 8weeks EEN, 65 were in remission, 32 improved and 12 had no improvement. By 4weeks, mean weight/BMI z-score (s.d.) increased (P<0.02) and between 4 and 8weeks (P<0.05). Baseline inflammatory markers all improved significantly by week 4 (albumin, CRP and platelets; all P<0.01) and ESR (P<0.00001). 63/109(58%) relapsed during follow-up. 44/63(70%) patients completed a second course of EEN with similar response rate, but lower weight gain (3.3 vs. 5.1kg, P<0.05). Height z-score did not change significantly over the 24months. Introduction of azathioprine within 6months of diagnosis did not improve height outcomes at 24months. Conclusions Weight and BMI z-score improved with EEN and changes are sustained to 2years, but height z-score did not. Seventy per cent of patients who relapsed during 2-year follow-up managed a 2nd course of EEN. The optimal therapeutic strategies for length of EEN course and to improve linear growth are awaited.