Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP
Melinda Moriczi, Gemma Pujol‐Muncunill, Rafael Martín‐Masot, Santiago Jiménez, Óscar Segarra, Carlos Ochoa Sangrador, Luis Peña Quintana, Daniel González Santana, Alejandro Rodríguez Martínez, A. Rosell Camps, H Armas, Josefa Barrio Torres, Rafael González de Caldas, Mónica Rodríguez Salas, Elena Serrano, Ester Donat, Andrés Bodas Pinedo, Esther Vaquero Sosa, Raquel Vecino López, Alfonso Solar Boga, Ana Moreno Álvarez, César Sánchez, María del Mar Tolín Hernani, Carolina Gutiérrez‐Junquera, Nazareth Martinón Torres, Rosaura Leis, Francisco Javier Eizaguirre, Mónica García Peris, Enrique Medina Benítez, Beatriz Fernández Caamaño, Ana María Vegas Álvarez, Laura Crespo Valderrábano, Carmen Vicente, Javier Rubio Santiago, Rafael Galera Martínez, Ruth García‐Romero, Ignacio Ros Arnal, S. Fernández Cebrián, Helena Lorenzo Garrido, Javier Francisco Viada Bris, Marta Velasco Rodríguez‐Belvís, Juan Manuel Bartolomé Porro, Miriam Blanco Rodríguez, Patricia Barros García, Gonzalo Botija, Francisco José Chicano Marín, E. La Orden Izquierdo, Elena Crehuá‐Gaudiza, Víctor Manuel Navas‐López, Javier Martín‐de‐Carpi
Abstract
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.