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P607. Prescription of enteral nutrition in paediatric Crohn's disease in Spain

Background

V.M. Navas-Lopez1, J. Martín-de-Carpi2, Ó. Segarra-Canton3, J.I. Garcia-Burriel4, J.J. Díaz-Martín5, A. Rodríguez-Martínez6, E. Medina-Benitez7, M. Juste-Ruiz8, 1Hospital Materno Infantil, Pediatric Gastroenterology and Nutrition Unit, Malaga, Spain, 2Hospital Sant Joan de Deu, Pediatric Gastroenterology and Nutrition Unit, Barcelona, Spain, 3Hospital Vall de Hebrón, Paediatric Gastroenterology and Nutrition Unit, Barcelona, Spain, 4Complexo Hospitalario Universitario de Vigo, Paediatric Gastroenterology and Nutrition Unit, Vigo, Spain, 5Hospital Universitario Central de Asturias., Paediatric Gastroenterology and Nutrition Unit, Oviedo, Spain, 6Hospital Universitario Virgen del Rocío Sevilla, Paediatric Gastroenterology and Nutrition Unit, Sevilla, Spain, 7Hospital Doce de Octubre, Paediatric Gastroenterology and Nutrition Unit, Madrid, Spain, 8Hospital Clínico Universitario San Juan de Alicante, Paediatric Gastroenterology and Nutrition Unit, San Juan de Alicante, Spain

Methods

Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids inducing mucosal healing in children with Crohn's disease (CD), without the side effects.

The aim of this study was to investigate the frequency and characteristics of the use of EEN in paediatric gastroenterology units in Spain through the use of a questionnaire prepared for this purpose.

Results

The questionnaire was based on other published studies, together with other previously unpublished items. The study was conducted by the IBD working group of the Spanish Society for Paediatric Gastroenterology, Hepatology and Nutrition (SEGHNP).

Conclusion

We received information from 51 Paediatric Gastroenterology Units. Of the 287 patients newly diagnosed with CD in 2011–2012 at these centres (139 in 2011, 148 in 2012), 182 (63%) received EEN (58% in 2011 and 68% in 2012). Twenty-six per cent (26%) of the patients who received EEN in the period studied (64/246) did so during relapses (Table 1).

The enteral formulas used most often were polymeric formulas specific for CD (70.6%) and the preferred administration route was oral, with 60.8% using flavouring and 9.3% allowing a variable percentage of calories in the form of other foods. The duration of EEN tends to be 8 weeks (47.1%), and transition to regular diet was preferably achieved sequentially in a variable time period. Regarding barriers and limiting factors for the use of EEN, those most frequently reported include lack of acceptance by the patient and/or family (71%).

Table 1 (abstract P607). Indications for EEN according to disease characteristics
Newly diagnosed vs. exacerbations76.5% only use EEN in newly diagnosed CD patients, not during relapses. 66.7% of those who use EEN in relapses only do so if the patient responded previously to EEN.
Behaviour43% indicate EEN only in cases of inflammatory phenotype (B1, nonstricturing, nonpenentrating)
Location37.3% only use EEN when only the ileum (L1) or ileum and colon (L3) are affected. 62.7% use EEN regardless of disease location and 31.4% do not use EEN when upper gastrointestinal tract (L4a or L4b) is affected. 50% do not use it in cases with extraintestinal manifestations.
PCDAI6% only in mild disease, 41.1% in mild to moderate disease and 52.9% regardless of disease severity.
Perianal disease70.6% use EEN to induce remission in cases of mild perianal manifestations (fissures or skin tags) or in cases of previously drained abscess.
Age70.6% use it regardless of age and 16.7% do not use it in patients under the age of 3.
Other factors62.7% only indicate EEN if the patient and their family are collaborative. 25.5% indicate it as the only therapeutic option. Delayed growth contributes to the prescription of EEN in 96.1% of subjects polled.
Table 2. Published studies about use of EEN in CD
StudyUSAEuropeCanadaIsraelAustraliaAsia-PacificAll data
Levine et al.4.3%61.8%36%19.2%
Steward et al.9%32%
Gråfors et al.65%
Whitten et al.100%92%75%89%
Day et al.38%
  • Written by: the present survey