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Molecular and Cellular Pediatrics

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Open Access 01-12-2022 | Crohn's Disease | Research

Implementation of exclusive enteral nutrition in pediatric patients with Crohn’s disease—results of a survey of CEDATA-GPGE reporting centers

Authors: Sarah Peters, Serdar Cantez, Jan De Laffolie, CEDATA Study Group

Published in: Molecular and Cellular Pediatrics | Issue 1/2022

Abstract

Background

Exclusive enteral nutrition (EEN) is the first-line therapy for pediatric-onset Crohn’s disease (CD) patients. CEDATA-GPGE® is the largest patient registry for children and adolescents with inflammatory bowel disease (IBD) in Europe, collecting data from over 5000 patients since 2004 in Germany and Austria. Since the application of EEN over 8 weeks is difficult and a high dropout rate is often described, the mode of application including a supporting structure is crucial for success. The aim of this study was to ascertain the variation in the application of EEN across the participating centers and to associate these with the outcome.

Results

Thirty-one centers responded to the survey (81.6%). 88.5% of CD patients were recommended EEN for induction therapy, 71.8% actually started with EEN, and 22.1% terminated the EEN prematurely. The duration of EEN typically lasted 6 to 8 weeks, and the polymeric formula was mainly used. 80.6% of the clinics added flavorings to the formulas. After EEN, the most preferred diet for maintenance therapy was a healthy, well-balanced diet considering individual intolerances.

Conclusions

EEN is widely recommended as an induction therapy by the German and Austrian pediatric gastroenterologists for children and adolescents with CD. However, this questionnaire-based study has shown a wide variation in EEN protocols used by the different pediatric clinics of CEDATA-GPGE®.

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de Laffolie J (2000) Epidemiologische Forschung und Behandlungsdatenanalyse zu chronisch-entzündlichen Darmerkrankungen - Verbesserung der Versorgung von Kindern und Jugendlichen. Monatsschr Kinderheilkd 168:298–313. https://doi.org/10.1007/s00112-020-00852-9CrossRef

Däbritz J, Gerner P, Enninger A et al (2017) Chronisch entzündliche Darmerkrankungen bei Kindern und Jugendlichen - Diagnostik und Therapie. Dtsch Arztebl 114:331–339. https://doi.org/10.3238/arztebl.2017.0331CrossRef

Bischoff SC (2020) Ernährung bei chronisch-entzündlichen Darmerkrankungen. Aktuel Ernährungsmed 45(5):363–379. https://doi.org/10.1055/a-1144-6840CrossRef

Hou JK, Abraham B, El-Serag H (2011) Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 106(4):563–573. https://doi.org/10.1038/ajg.2011.44CrossRefPubMed

Limketkai BN, Iheozor-Ejiofor Z, Gjuladin-Hellon T et al (2019) Dietary interventions for induction and maintenance of remission in inflammatory bowel disease (Review). Cochrane Database Syst Rev 2:1–83. https://doi.org/10.1002/14651858.CD012839.pub2CrossRef

Preiß JC, Bokemeyer B, Buhr HJ et al (2014) Aktualisierte S3-Leitlinie - “Diagnostik und Therapie des Morbus Crohn”. Z Gastroenterol 52(12):1431–1484. https://doi.org/10.1055/s-0034-1385199CrossRefPubMed

van Rheenen PF, Aloi M, Assa A et al (2020) The medical management of paediatric Crohn’s. J Crohns Colitis 15(2):171–194. https://doi.org/10.1093/ecco-jcc/jjaa161CrossRef

Ho SS, Day AS (2019) Exclusive enteral nutrition in children with inflammatory bowel disease: physician perspectives and practice. JGH 3(2):148–153. https://doi.org/10.1002/jgh3.12121CrossRef

Ishige T, Tomomasa T, Tajiri H et al (2017) Japanese physicians’ attitudes towards enteral nutrition treatment for pediatric patients with Crohn’s disease: a questionnaire survey. Intest Res 15(3):345–351. https://doi.org/10.5217/ir.2017.15.3.345CrossRefPubMedPubMedCentral

10.

Levine A, Milo T, Buller H et al (2003) Consensus and controversy in the management of pediatric Crohn disease: an International Survey. JPGN 36(4):464–469. https://doi.org/10.1097/00005176-200304000-00008CrossRefPubMed

11.

Whitten KE, Rogers P, Ooi CK et al (2012) International survey of enteral nutrition protocols used in children with Crohn’s disease. J Dig Dis 13(2):107–112. https://doi.org/10.1111/j.1751-2980.2011.00558.xCrossRefPubMed

12.

Buderus S, Scholz D, Behrens R et al (2015) Chronisch entzündliche Darmerkrankungen bei pädiatrischen Patienten - Charakterisierung von neuerkrankten Patienten aus dem Register CEDATA-GPGE. Dtsch Arztebl 112(8):121–126. https://doi.org/10.3238/arztebl.2015.0121CrossRef

13.

Sigall-Boneh R, Pfeffer-Gik T, Segal I et al (2014) Partial enteral nutrition with a Crohn’s disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease. Inflamm Bowel Dis 20(8):1353–1360. https://doi.org/10.1097/MIB.0000000000000110CrossRefPubMed

14.

Stewart M, Day AS, Otley A (2011) Physician attitudes and practices of enteral nutrition as primary treatment of paediatric Crohn disease in North America. JPGN 51(1):38–42. https://doi.org/10.1097/MPG.0b013e3181e2c724CrossRef

15.

Navas-López VM, Martín-de-Carpi J, Segarra O et al (2014) Present; prescription of enteral nutrition in pediatric Crohn’s disease in Spain. Nutr Hosp 29(3):537–546. https://doi.org/10.3305/NH.2014.29.3.7184CrossRefPubMed

16.

Gråfors JM, Casswall TH (2011) Exclusive enteral nutrition in the treatment of children with Crohn’s disease in Sweden: a questionnaire survey. Acta Peadiatrica 100(7):1018–1022. https://doi.org/10.1111/j.1651-2227.2011.02178.xCrossRef

17.

Terry A, Grogan JL, Casson DH et al (2011) Tube feeding therapy in paediatric Crohn’s disease. Aliment Pharmacol Ther 34(2):252–261. https://doi.org/10.1111/j.1365-2036.2011.04720.xCrossRef

18.

Koletzko S, Siegert T (2004) Ernährungstherapie der chronisch-entzündlichen Darmerkrankungen. Monatsschr Kinderheilkd 152:145–152. https://doi.org/10.1007/s00112-004-0887-2CrossRef

19.

Ruemmele F M, Veres G, Kolho K L, et. Al (2014) Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis 8(10):1179–1207. doi:https://doi.org/10.1016/j.crohns.2014.04.005

20.

Svolos V, Hansen R, Nichols B et al (2019) Treatment of active Crohn’s disease with an ordinary food-based diet that replicates exclusive enteral nutrition. Gastroenterology 156(5):1354–1367. https://doi.org/10.1053/j.gastro.2018.12.002CrossRefPubMed

21.

Bischoff SC, Koletzko B, Lochs H et al (2014) S3-Leitlinie der DGEM: Klinische Ernährung in der Gastroenterologie (Teil 4) Chronisch-entzündliche Darmerkrankungen. Aktuelle Ernahrungsmedizin 39(3):72–98. https://doi.org/10.1055/s-0034-1370084CrossRef

22.

Narula N, Dhillon A, Zhang D et al (2018) Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 4(4):CD000542. https://doi.org/10.1002/14651858.CD000542.pub3CrossRefPubMed

23.

Herrador-López M, Martín-Masot R, Navas-López VM (2020) EEN yesterday and today. CDED Today and Tomorrow. Nutrients 12:3793. https://doi.org/10.3390/nu12123793CrossRefPubMedCentral

24.

Sigall-Boneh R, Sarbagili Shabat C, Yanai H et al (2017) Dietary therapy with the crohn’s disease exclusion diet is a successful strategy for induction of remission in children and adults failing biological therapy. J Crohns Colitis 11(10):1205–1212. https://doi.org/10.1093/ecco-jcc/jjx071CrossRefPubMed

25.

Levine A, Wine E, Assa A et al (2019) Crohn's disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial. Gastroenterology 157(2):440–450. https://doi.org/10.1053/j.gastro.2019.04.021CrossRefPubMed

26.

Miele E, Shamir R, Aloi M et al (2018) Nutrition in pediatric inflammatory bowel disease: a position paper on behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology. Hepatol Nutr 66(4):1. https://doi.org/10.1097/MPG.0000000000001896CrossRef

27.

de Laffolie J, Schwerdt T, Simon A et al (2020) Crohn’s Disease Exclusion Diet (CDED) als Alternative zur exklusiven Ernährungstherapie bei Kindern und Jugendlichen mit Morbus Crohn? Z Gastroenterol 58(9):890–894. https://doi.org/10.1055/a-1199-6751CrossRefPubMed

28.

Fangmann D, Hötte T, Laudes M (2017) Chronisch-entzündliche Erkrankungen - Ansatzpunkte für die Ernährungstherapie. Ernährungs Umschau 12:699–709. https://doi.org/10.4455/eu.2017.050CrossRef

29.

Owczarek D, Rodacki T, Domagała-Rodacka R et al (2016) Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol 22(3):895–905. https://doi.org/10.3748/wjg.v22.i3.895CrossRefPubMedPubMedCentral

30.

Alexy U, Hilbig A, Lang F (2020) Ernährungspraxis Säugline, Kinder und Jugendliche - Beratungswissen kompakt. Deutscher Apotheker Verlag, Stuttgart

31.

Schnell R, Hill PB, Esser E (2018) Methoden der empirischen Sozialforschung. De Gruyter Oldenbourg 11 überarbeitete Auflage

Title: Implementation of exclusive enteral nutrition in pediatric patients with Crohn’s disease—results of a survey of CEDATA-GPGE reporting centers
Authors: Sarah Peters
Serdar Cantez
Jan De Laffolie
CEDATA Study Group
Publication date: 01-12-2022
Publisher: Springer International Publishing
Keywords: Crohn's Disease
Chronic Inflammatory Bowel Disease
Nutrition
Published in: Molecular and Cellular Pediatrics / Issue 1/2022
Electronic ISSN: 2194-7791
DOI: https://doi.org/10.1186/s40348-022-00139-x

At a glance: The STEP trials

Springer Medicine

Implementation of exclusive enteral nutrition in pediatric patients with Crohn’s disease—results of a survey of CEDATA-GPGE reporting centers

Abstract

Background

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Results

Conclusions

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