P549 Short and long term therapeutic Efficacy of Oral Nutritional Therapy in pediatric Crohn's Disease ; A Single Center Experience
H.J. Kim*, J.M. Cho, K.M. Kim, S.H. Oh
Seoul Asan Medical Center , Pediatrics , Seoul , South Korea
Exclusive enteral nutrition (EEN) is as effective as corticosteroids at inducing remission and have direct impact on improving nutritional complications. However data on maintaining disease remission and resumption of normal growth with partial enteral nutrition (PEN) are scare.
The present retrospective analysis aims to demonstrate the short- and long-term therapeutic efficacy of oral nutritional therapy (ONT) in children upon disease activity and growth parameters.
Patients newly diagnosed with moderate to severe CD in December 2004 to February 2013 who were managed with exclusive oral elemental nutrition therapy to induce remission at Asan Medical Center Children`s Hospital and followed up more than years with partial ONT were enrolled. Data were retrospectively collected from patients' medical records including basic demographics, clinical, laboratory findings.
Twenty four of the 25 patients (96%) achieved clinical remission, with a median time to remission of 29 days. In children responding to ONT, mean Pediatric CD Activity Index (PCDAI) decreasing from 37.35 ± 14.01 to 5.44 ± 5.23 after 6 weeks and 3.24 ± 3.45 after 1 year. Five patients discontinued exclusive ONT within 6 weeks and 8 patients withdrawals partial ONT after 6 weeks due to unplatable enteral formula. Between presentation and 12 months after ONT, there was a significant increase in standardized z -scores for weight for height and Body Mass Index (BMI). The cumulative probability of relapse was 66 % at 1 year and 50 % at 2 years, respectively. If we excluded the patients (n=8) who had poor compliance to nutrition therapy, the cumulative probability of relapse was 82 % at 1 year and 70 % at 2 years, respectively.
EEN and PEN can be the effective treatment for inducing and maintain remission without relapse. A randomized controlled trial would be beneficial in helping to clarify these provisional findings further.