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Article Dans Une Revue Alimentary Pharmacology and Therapeutics Année : 2011

Efficacy of exclusive nutritional therapy in pediatric Crohn's disease comparing fractionated oral versus continuous enteral feeding

Amandine Rubio
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Benedicte Pigneur
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  • PersonId : 912475
Helene Garnier-Lengliné
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Cecile Talbotec
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Jacques Schmitz
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Danielle Canioni
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Olivier Goulet
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  • PersonId : 907897

Résumé

Background: Nutritional therapy has an established role as induction therapy in paediatric Crohn's disease (CD). However, compliance is the main difficulty and may be greatly influenced by the administration route. Aim: To analyse efficiency of exclusive nutrition to induce remission in children with CD comparing fractionated oral versus continuous enteral feeding. Methods: The medical records of 106 patients treated by exclusive nutritional therapy (Modulen IBD®) by either oral or continuous enteral route were reviewed retrospectively. Comparative analyses of remission rates, changes in anthropometry, Paediatric CD Activity Index (PCDAI), laboratory indices and compliance rates were performed. Results: On exclusive enteral nutrition, at 8 weeks, 34/45 patients achieved remission in the oral group (75% on intention-to-treat analysis) and 52/61 (85%) in the enteral nutrition group (P=0.157). All patients showed a significant decrease in disease severity assessed by PCDAI (P<0.0001) and significant improvements in anthropometric measures and inflammatory indices. No difference was observed whether Modulen IBD® was administered orally or by continuous enteral feeding, apart from weight gain which was greater in the enteral group (P=0.041). In a subgroup of patients mucosal healing was evidenced on follow-up endoscopies showing a clear correlation to remission. Compliance rates (87 and 90%) were similar. Nevertheless, non-compliant patients had lower mucosal healing and remission rates. Conclusions: These retrospective data suggest that the use of fractionated oral nutritional therapy might be as efficacious as continuous enteral administration to induce remission and mucosal healing in children with CD. However, appropriate prospective clinical trials are needed to confirm these findings.

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Dates et versions

hal-00633994 , version 1 (20-10-2011)

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Amandine Rubio, Benedicte Pigneur, Helene Garnier-Lengliné, Cecile Talbotec, Jacques Schmitz, et al.. Efficacy of exclusive nutritional therapy in pediatric Crohn's disease comparing fractionated oral versus continuous enteral feeding. Alimentary Pharmacology and Therapeutics, 2011, ⟨10.1111/j.1365-2036.2011.04662.x⟩. ⟨hal-00633994⟩

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