Exclusive enteral nutrition in Crohn’s disease pediatric patients: from clinical remission to transmural healing

Abstract

Background and Aims. Exclusive enteral nutrition (EEN) is a well-established first-line therapy for inducing remission in mild-to-moderate pediatric Crohn’s disease (pCD). While clinical remission (CR) and mucosal healing (MH) are widely accepted therapeutic goals, the concept of transmural healing (TH) has gained increasing recognition. This study aimed to evaluate the effectiveness of EEN in pCD patients from Romania, focusing on nutritional status, remission outcomes, and the impact of various factors on treatment efficacy.

Methods. We conducted a retrospective observational study of pCD consecutive patients who received EEN for induction of remission between 2007 and 2017 at a referral center in Cluj-Napoca, Romania. CR was defined as a weighted Pediatric Crohn’s Disease Activity Index (wPCDAI) <12.5, MH as a fecal calprotectin level <250 microg/g, and TH as the combination of MH and imagistic remission assessed by intestinal ultrasonography. Statistical analyses included descriptive and comparative approaches, including logistic regression, with p <0.05 considered significant.

Results. Twenty patients with pCD, representing 45% of the cohort, were included. The median age at diagnosis was 14.2 years (9.9–18.4), and 65% were male. EEN was administered with a mean duration of 7.84±1.26 weeks. Body mass index Z-scores significantly improved following EEN (p=0.02). Hypoalbuminemia, detected in 55% of patients at diagnosis, resolved completely after EEN (p=0.00015). CR was achieved in 82% of patients with active clinical disease, MH in 26% of patients with microscopic activity, and TH in 20% of patients with imagistic activity. Age at diagnosis, disease behavior, location, activity, and anti-Saccharomyces cerevisiae antibody status were not significantly associated with CR or MH. Disease activity at initiation, measured by the wPCDAI, was inversely associated with TH (p=0.004).

Conclusions. This is the first study to report on EEN outcomes in pCD patients from Romania. EEN was effective in improving nutritional status and inducing CR, while MH was achieved in about one-quarter of patients. TH was also observed, though less frequently, and was negatively associated with higher baseline clinical disease activity. Regional factors may have influenced these outcomes.