P435 Maintenance of Remission with Partial Enteral Nutrition Therapy in pediatric Crohn's Disease: A retrospective study.
J. Schulman, R. Shaoul*
Rambam Medical Center, Pediatric Gastroenterology, Haifa, Israel
Exclusive Enteral Nutrition (EEN) is recommended as first line therapy to induce remission in pediatric Crohn's Disease (CD). A previous pediatric CD study showed that partial enteral nutrition (PEN) was associated with prolonged remission and better linear growth after EEN treatment. Several adult studies have showed the advantage of PEN in maintaining remission. Data on the ability of PEN in maintaining remission in pediatric CD is still lacking. We maintain all our CD patients on PEN (50% of total calories as polymeric diet) for at least one year.
We conducted a retrospective study in which we investigated the maintenance of remission in 44 pediatric CD patients who entered clinical remission on 6-8 weeks of EEN. To evaluate this, we have reviewed patients' charts and pooled demographic and follow-up data. In order to assess efficacy in maintaining remission we have used the Pediatric Crohn's Disease Activity Index (PCDAI), Physicians global assessment (PGA), laboratory parameters (Hb, ESR, CRP, albumin) and the growth data of each patient over a time period of approximately 12 months.
The patients (27% female, mean age at diagnosis 11.8 (range 6.6-18.6) years) were followed up for a mean duration of 50 months. The mean remission length achieved on EEN treatment, followed by PEN was 9.6 months (range 0-36 months). Patients were maintained on PEN without concomitant medications for a mean time of 3.5 months. Concomitant medications during this period were: steroids (61%), thiopurines (84%), biologic treatment (32%), methotrexate (16%) and antiobiotics (45%). Mean BMI increased from 17.1 before EEN to 18.2 after EEN, followed by an increase to 19.0 after 6 months of PEN
PEN may be helpful in improving maintenance of remission and improves nutritional status. Further studies to assess efficacy are mandated.