Exclusive Whole Protein Enteral Diet Versus Prednisolone in the Treatment of Acute Crohnʼs Disease in Children

Abstract

Nineteen children with either newly diagnosed or relapsed Crohn's disease were enrolled in a randomized study in which the efficacy of enteral feeding with a whole protein-based formula was compared to high-dose corticosteroids in achieving clinical remission and normalization of laboratory measurements. Ten children were treated by enteral feeding (Nutrison Standard, Nutricia), and nine received corticosteroids. Both treatment regimens lasted 11 weeks. The activity of Crohn's disease was similar in both groups before the commencement of the treatment. Clinical symptoms and signs, as judged by the pediatric Crohn's disease activity index and measurements relating to inflammatory activity (erythrocyte sedimentation rate, C-reactive protein, blood leukocyte and platelet count, and serum immunoglobulins G and A) and to nutritional status (concentrations of serum albumin, prealbumin, hemoglobin) improved rapidly and significantly with as little as 2 weeks' treatment in both treatment groups. In both groups, there was one relapse within 8 weeks after discontinuation of treatment, and one patient in both groups was operated on during the treatment period. During the routine follow-up after the trial (0.3–2.5 years; mean, 1.3 years) five of the corticosteroid group experienced a clinical relapse, whereas only one from the enteral feeding group relapsed. No side effects of enteral feeding were seen. Enteral feeding with a whole protein-based formula proved to be as effective as high-dose corticosteroid in the treatment of the acute phase of Crohn's disease and may prove to be the treatment of choice in pediatric patients with acute Crohn's disease.