P629 Improvement of nutritional status and growth velocity as an additional benefit from using the exclusive enteral nutrition to induce remission in children with active Crohn’s disease
M. Matuszczyk*1, M. Meglicka1, P. Landowski2, B. Sordyl3, E. Czkwaniec3, J. Kierkuś1
1The Children’s Memorial Health Institute, Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, Warsaw, Poland, 2Medical University of Gdańsk, Gdańsk, Poland, 3Polish Mother’s Memorial Hospital Research Institute, Łódź, Poland
Undernutrition and growth failure are common problems in paediatric patients with active CD. The aim of introduction of exclusive enteral nutrition (EEN) is not only to induce the remission and but also to initiate the weight and growth gain, especially in patients with poor nutritional status. We assessed the effectiveness of treatment by EEN and its effect on the optimisation of the nutritional status in children with active CD.
In total, 20 children (male/female: 14/6) with median age of 14 years with acute CD were treated for 6 weeks by EEN with polymeric industrial diet (Modulen IBD). The daily caloric intake was established depending on the age and nutritional status. In patients with undernutrition it was increased to 120%–150% relative to recommendation for the healthy peers. The PCDAI and nutritional status were assessed at baseline and 4 weeks after the end of therapy.
The mean reduction of PCDAI was statistically significant (from 26.3 ± 13.2 to 7.8 ± 11.6, p < 0.05) in the studied group. Full remission (reflected by PCDAI<10) was achieved in 65%; clinical response in 30%; and no response in 5% of children. Only 1 child was fed by nasogastric tube, and in the rest, the oral intake of industrial formula was accepted. EEN was generally well tolerated initially; however, in 20% of patients, the symptoms of industrial diet intolerance were observed, but they receded within the first days of therapy. In 95%, the recommended daily volume of formula was met; only 1 child was not able to intake the prescribed amount of diet because of intolerance. At baseline, 30% of patients was undernourished, and that was reflected by BMI below the third percentile on the WHO charts. In all patients, improvement of BMI status was achieved at the end of treatment. The mean increase of BMI was 0.91, and it was greater in the undernourished group than in patients with normal nutritional status (1.19 vs 0.62). In two-thirds of malnourished children, the BMI status met the normal value after treatment. Before the introduction of EEN in 25% of patients, the deficit of growth was stated based on growth below the third percentile on the WHO charts. The growth gain was obtained generally in 55% of children and amongst 80% in the group with initial growth failure. The mean increase of growth was 1 cm, and it was greater in the group with the impaired growth compare with patients with normal values for age (1.5 cm vs 08 cm).
The 6-week course of EEN was an effective and well-tolerated method of treatment in the studied group. It not only induced full remission in most patients, but also helped to normalise the impaired nutritional status and growth velocity, which is of particular importance in paediatric patients with CD.