P751 Crohn’s Disease Exclusion Diet: A single centre real-life experience.
Lababidi, N.E.(1)*;Pavel, F.(1);
(1)First Faculty of Medicine- Charles University and General University Hospital in Prague, Department of Paediatrics and Inherited Metabolic Disorders, Prague 2, Czech Republic;
Background
According to ECCO-ESPGHAN consensus guidelines, exclusive enteral nutrition (EEN) is the first line therapy for induction of remission in children with active luminal Crohn's disease (CD). Steroids may be considered in cases when EEN is not an option. However, adherence to EEN is not ideal. According to various sources it ranges from 50-91 %. This poor adherence is mainly due to palatability and monotony. Many attempts have been made to find an alternative to EEN. One of them is Crohn’s Disease Exclusion Diet (CDED) with partial enteral nutrition (PEN), which shows promising results in efficacy, safety, and adherence. This study evaluates the efficacy of CDED with PEN in a single European centre.
Methods
Retrospective evaluation of prospectively collected dated of children treated with CDED with PEN between 10/19-11/22. Wellbeing, anthropometric data, and laboratory results were evaluated prior to the commencement of CDED with PEN and at the end of both phases 1 and 2. A mean, median and a standard deviation were calculated were applicable. ANOVA was used for evaluation of presence of statistically significant differences and a P-value ≤ 0.05 was regarded as such.
Results
CDED with PEN was used in 24 patients. The mean age at diagnosis was 14.6±3.7 years. At the time of evaluation, 21/24 patients have completed phase 1 and 20/24 have completed phase 2. Three patients were still in phase 1 and 1 in phase 2. One patient decided to quit CDED with PEN at the end of phase 1 and 2 more at the end of phase 2. All patients, who started phase 1 completed it, and 95.2% completed phase 2. Non-adherence was recorded in two patients: once in diet composition and twice in PEN volume.
At commencement of CDED with PEN, dietary intervention was the only treatment in 16/24 patients. Three patients were on Azathioprine (AZA), 2 5-aminosalicylic acid (5-ASA), 1 Methotrexate (MTX) and another Prednisone. At the end of phase 1, 8 patients were on anti-TNF-α, 8 were using AZA, 2 5-ASA and 1 MTX. At the end of the phase 2, anti-TNF-α was used in 12 patients, AZA in 8, MTX in 3 and both anti-IL12/23 and 5-ASA in 1 patient.
CRP and ESR showed a statistically significant decrease (P< 0.01) at the end of phases 1 and 2, Faecal calprotectin (FC) showed so at the end of phase 2 (P< 0.01). Other followed parameters failed to show a significant difference at the end of follow-up.
Conclusion
These data support that CDED with PEN is both well tolerated and has a very high adherence rate. They also confirm that CRP and ESR decrease significantly at the end of both phases and FC at the end of phase 2. CDED with PEN should be considered as an alternative to EEN and steroids in induction of remission of luminal CD in children.