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P538. Duration of remission with exclusive enteral nutrition in Crohn's disease

F. Flor-de-Lima1, J. Cardoso1, R. Marques1, M. Tavares1, E. Trindade1, J. Amil-Dias1, 1Unit of Pediatric Gastroenterology, Centro Hospitalar de São João, Porto, Portugal

Background

Current guidelines recommend the use of exclusive enteral nutrition (EEN) to induce remission in Crohn's Disease (CD). EEN is known to have similar clinical effects to steroids, increased mucosal healing, better nutritional improvement and fewer side effects. However the duration of remission with both regimens has not been completely elucidated. To address this issue we compared a group of patients treated with EEN plus low dose steroids with a historical control group of conventional steroids.

Methods

Clinical records of patients with CD, diagnosed according to Porto criteria, and treated at a tertiary hospital since 1994 were reviewed. Patients treated with other regimens than EEN or steroids at diagnosis were excluded. Demographic and clinical data were analyzed. Disease was expressed according to Paris Classification and activity according to Harvey–Bradshaw Index.

Results

Sixty three patients were included, 44 (69.8%) males, with mean age at diagnosis of 12.3 years (4–17). Thirty seven (58.7%) started EEN plus low dose steroids (0.5 mg/kg/d, max 20 mg/d) at diagnosis and 26 (41.3%) steroids alone (1 mg/kg/d, max 40 mg). All patients in both groups started azathioprine early in the treatment. Localization was L3 in 42.9%, followed by L1 (17.5%) and L3+L4a (14.3%). Anal lesions occurred in 16 (25.4%) cases. Steroid group had L1 disease in 37.5% and EEN group had L3 disease in 52.8% associated to upper disease in 25% (p < 0.05). The presence of anal lesions was similar in both groups. Steroid group had mild disease in 80.8% and EEN group had moderate-severe disease in 48.6% (p < 0.05). At diagnosis, median ESR was 47 mm/1st hour (4–97), higher in steroid group (p = 0.011) Median treatment duration was 10 weeks (3–556). Relapse occurred in 52.4% of cases, similar in both groups. Median time to relapse was 5 months (max 72). Patients treated with EEN had the first relapse 5 months (median) after diagnosis (max 20) vs patients treated with steroids who relapsed at 5.5 months (max 72) (p > 0.05). There were no differences between both groups after multivariate analysis.

Conclusion

EEN induces remission in Crohn's Disease with clear nutritional advantages over steroids. However, from these results duration of remission may not be longer than steroids alone. Further studies to evaluate duration of remission are needed.