The review, published in Alimentary Pharmacology & Therapeutics, pooled data from eight randomised clinical trials with more than 450 participants to analyse the efficacy of exclusive enteral nutrition (EEN) compared to the use of corticosteroids.
EEN is a medical nutrition practice in which individuals only receive liquid nutrition. The process is believed to reduce incidence of enteral antigens resulting in improvements in intestinal permeability, however recent studies have suggested mechanisms could include down regulation of pro-inflammatory cytokines and driving beneficial changes to the gut microbiome.
The team noted that while EEN is often used as a Crohn’s therapy in some parts of Europe, other areas of the world – including the USA – have not moved away from the use of corticosteroids despite potential adverse-events in children.
Led by Dr Arun Swaminath from Lenox Hill Hospital, New York, the new analysis finds that EEN is just as effective as steroids in controlling the inflammation of Crohn's disease whether during the first attack or a relapse.
In addition, healing of the intestine was over 4-times more likely in the EEN patients than in those given steroids, they said.
“In summary, our study suggests that exclusive enteral nutrition works equally as well as corticosteroids in inducing remission in paediatric Crohn's disease based on clinical symptom scores, but EEN could potentially be superior when assessing improvement by mucosal healing end points,” wrote the team.
They added that EEN may also have the added benefit of minimising growth failure, avoiding undesirable and difficult to reverse changes to body habitus, and can potentially result in a deeper and longer duration of remission.
As such, Swaminath and colleagues argue that ‘greater advocacy’ for EEN is needed among physicians and healthcare professionals – especially in the USA.
Source: Alimentary Pharmacology & Therapeutics
Published online ahead of print, doi: 10.1111/apt.14253
“Systematic review with meta-analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn's disease”
Authors: A. Swaminath, et al