Assessment of small intestine mucosal healing by capsule endoscopy in pediatric Crohn disease after exclusive enteral nutrition treatment

2008 ◽  
Vol 40 (10) ◽  
pp. A91
Author(s):  
C. Brondello ◽  
E. Pozzi ◽  
F. Mangiantini ◽  
M. Lorusso ◽  
S. Bevilacqua ◽  
...  
Keyword(s):  
Small Intestine ◽  
Enteral Nutrition ◽  
Capsule Endoscopy ◽  
Crohn Disease ◽  
Mucosal Healing ◽  
Exclusive Enteral Nutrition

Smoking and Diet: Impact on Disease Course?

2016 ◽  
Vol 34 (1-2) ◽  
pp. 72-77 ◽  
Author(s):  
Jacques Cosnes
Keyword(s):  
Smoking Cessation ◽  
Enteral Nutrition ◽  
Beneficial Effect ◽  
Vegetarian Diet ◽  
Mucosal Healing ◽  
Disease Course ◽  
Dietary Interventions ◽  
Current Smoking ◽  
Exclusive Enteral Nutrition ◽  
The Impact

Background: The impact of current smoking on inflammatory bowel disease (IBD) course has been studied extensively; smoking is deleterious in Crohn's disease (CD), and beneficial in ulcerative colitis (UC). Except for enteral nutrition, there are only limited data regarding the impact of diet on disease course. Key Messages: Current smoking worsens the course of CD, increasing the incidence of flares, the need for steroids, immunosuppressants and re-operations. Conversely, smoking cessation has a rapid beneficial effect on disease course, decreasing the risk of flares and of post-operative recurrences. From 3 months after the quit date, quitters have a disease course similar to that of never smokers. Achieving smoking cessation in CD is thus an important goal of therapy. On the contrary, smoking improves the course of UC and in particular, is associated with a decreased need for colectomy. Smoking cessation increases the risk of flare and the need for steroids or immunosuppressants. However, patients with UC should not be discouraged to quit, because the beneficial effect of smoking for their disease is counterbalanced by the deleterious systemic effects of tobacco. Among dietary interventions, only exclusive enteral nutrition was shown to induce remission and achieve mucosal healing in some patients with CD. The beneficial effect of liquid-defined diet is observed whatever be the type of administration (orally or by tube), the type of diet regarding protein and fat content and resulting alterations in the gut microbiota. In UC, enteral nutrition has no effect. Finally, popularized restrictive diets in IBD as the specific-carbohydrate diet and the gluten-free diet have not been rigorously tested. In a small trial, a semi-vegetarian diet was shown to be effective in maintaining remission over 2 years in CD. Conclusions: Patients with IBD should not smoke and avoid passive smoking. Aside from the defined liquid diets, there is no rationale for advising particular diets.

Video Capsule Endoscopy and Deep Enteroscopy

2017 ◽  
Author(s):  
Neil Marya ◽  
Veronica Baptista ◽  
Anupam Singh ◽  
Joseph Charpentier ◽  
David Cave
Keyword(s):  
Small Intestine ◽  
Small Bowel ◽  
Carcinoid Tumor ◽  
Capsule Endoscopy ◽  
Crohn Disease ◽  
Malignant Tumors ◽  
Video Capsule Endoscopy ◽  
X Rays ◽  
Small Bowel Tumors ◽  
Peutz Jeghers Syndrome

Until 2001, the nonsurgical evaluation of the small intestine was largely limited to the use of radiologic imaging (e.g., small bowel follow-through or enteroclysis). With the now widespread availability of video capsule endoscopy and deep enteroscopy since 2001, we are now able to visualize the length and most of the mucosa of the small intestine and manage small bowel lesions that were previously inaccessible except by surgical intervention. This review serves as an overview for these two procedures, detailing the indications and contraindications, proper timing of the procedure, technical aspects of the devices themselves, possible complications, and outcomes. Figures show endoscopic images that demonstrate multiple angioectasias, bleeding during capsule endoscopy, active Crohn disease of the small bowel, severe mucosal scalloping, small bowel carcinoid tumor, small bowel polyp associated with Peutz-Jeghers syndrome, and nonsteroidal antiinflammatory drug enteropathy; serial x-rays of a patient with a patency capsule retained inside the small intestine; a computer image showing the distribution of small bowel tumors; and a pie chart displaying the breakdown of the distribution of benign and malignant tumors that can be found in the small intestine. Videos show multiple angioectasias, bleeding during capsule endoscopy, active Crohn disease of the small bowel, small bowel carcinoid tumor, and small bowel polyp associated with Peutz-Jeghers syndrome. This review contains 10 highly rendered figures, 5 videos, and 50 references.

Parent Perspectives on Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn Disease

2020 ◽  
Vol 71 (6) ◽  
pp. 744-748 ◽  
Author(s):  
Pooja Mehta ◽  
Zhaoxing Pan ◽  
Glenn T. Furuta ◽  
David Yonghyuk Kim ◽  
Edwin F. de Zoeten
Keyword(s):  
Enteral Nutrition ◽  
Crohn Disease ◽  
Parent Perspectives ◽  
Exclusive Enteral Nutrition

scholarly journals OP15 Cyclic exclusive enteral nutrition to maintain longterm drug-free remission in Paediatric Crohn’s Disease: The CD HOPE study of the GETAID pédiatrique

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S015-S015
Author(s):  
B Pigneur Arnaud ◽  
C Martinez-Vinson ◽  
A Bourmaud ◽  
G Swellen ◽  
R Duclaux-Loras ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Induction Therapy ◽  
Drug Exposure ◽  
Nutritional Supplement ◽  
Mucosal Healing ◽  
Dietary Therapy ◽  
Exclusive Enteral Nutrition ◽  
Caloric Requirement ◽  
Group A ◽  
Group B

Abstract Background To address the question if pediatric CD patients responding to nutritional induction therapy can be maintained in remission on dietary therapy without the use of immunosuppressive drugs, we designed a prospective randomized trial (CD-HOPE) comparing cyclic exclusive enteral nutrition (EEN) to daily supplement over a 12 month period. Methods CD patients (6–17 years) who successfully completed at least 6 weeks of EEN with clinical remission (wPCDAI ≤12.5) were recruited in 21 sites of the French GETAID pédiatrique between 12.2014 and 09.2018. All drug therapy had to be stopped at least 4 weeks prior to inclusion. A total of 112 patients were screened with 100 patients randomized to group A cyclic EEN (100% of caloric requirement) every 8 weeks for 2 weeks or group B daily supplementary nutrition (25% of caloric requirement). Patient stratification according to age (< 10 years or older) and previous drug exposure or not. EEN and the nutritional supplement were in form of MODULEN IBD®. Except for the two weeks of EEN in group A food access was not restricted. Primary objective was the comparison of relapse rates at 12 months (defined as a wPCDAI >12.5 at two consecutive visits) between the two groups (log-rank test per protocol). Additional analyses were performed using a multivariate regression analysis and cox model. Results 49 CD patients were randomized to group A (cyclic EEN) and 51 to group B (daily supplement) with 43/49 and 44/51 newly diagnosed patients without any previous drug exposure. Baseline characteristics were comparable between the two groups. Median age was 12 and 13 years, group A and B respectively. At the final 12 months visits a total of 25/49 patients (group A) remained in remission without disease activation compared to 12/51 patients (group B) (p=0.004) with a hazard ratio of 0.48 (0.29–0.80) (p= 0.0051). Kaplan Maier survival remission rates are shown in figure 1. Mean fecal calprotectine levels showed no significant difference between the two groups (297, 399 and 469 at month 0, 3, and 12 visits in group A and 480, 606, and 283 at month 0,3, and 12 visits in group B). Mucosal healing at M12 months was achieved in 25/49 patients (group A) and 18/51 patients (group B), with a mucosal healing rate of 52% (group A) and 33% (group B). Both treatment arms showed a significant catch-up growth. Conclusion This is first trial indicating that children/adolescents with CD responding to EEN as induction therapy can be maintained on remission with a nutritional therapy without immunosuppressors/biologics. However, daily nutritional supplement with normal access to food was not successful with a relapse rate of 76%. This study was supported by an unrestricted grant from Nestlé Health Science and sponsored by APHP.

Effect of Exclusive Enteral Nutrition on Renal Function for Granulomatous Interstitial Nephritis Associated With Crohn Disease

2020 ◽  
Vol 26 (11) ◽  
pp. e142-e143
Author(s):  
Haruna Nakaseko ◽  
Daisuke Nishida ◽  
Naoki Abe ◽  
Kazuki Tanaka ◽  
Naoya Fujita ◽  
...  
Keyword(s):  
Renal Function ◽  
Enteral Nutrition ◽  
Interstitial Nephritis ◽  
Crohn Disease ◽  
Granulomatous Interstitial Nephritis ◽  
Exclusive Enteral Nutrition

scholarly journals Mucosal Healing and Bacterial Composition in Response to Enteral Nutrition Vs Steroid-based Induction Therapy—A Randomised Prospective Clinical Trial in Children With Crohn’s Disease

2018 ◽  
Vol 13 (7) ◽  
pp. 846-855 ◽  
Author(s):  
Bénédicte Pigneur ◽  
Patricia Lepage ◽  
Stanislas Mondot ◽  
Jacques Schmitz ◽  
Olivier Goulet ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Enteral Nutrition ◽  
Intestinal Microbiota ◽  
Clinical Remission ◽  
Molecular Mechanisms ◽  
Mucosal Healing ◽  
Bacterial Composition ◽  
Exclusive Enteral Nutrition ◽  
Index Of Severity

AbstractAimsExclusive enteral nutrition [EEN] is as efficacious as corticosteroids [CS] to induce remission in Crohn’s disease [CD], without their adverse effects. EEN seems to be more efficient than steroids to induce mucosal healing, but the underlying molecular mechanisms are only sparsely understood. We aimed in the present work to study the anti-inflammatory effects of EEN with Modulen IBD® vs CS in active paediatric CD, and to assess its modulatory effects on the intestinal microbiota as compared with steroids.Materials and MethodsNineteen patients with new-onset active CD (Harvey-Bradshaw index [HBI] >5), aged from 6 to 17 years, were included in this prospective randomised induction trial with CS [n = 6] or EEN [n = 13]. Patients were assessed at Weeks 0 and 8 using clinical parameters HBI, endoscopic findings (Crohn’s Disease Endoscopic Index of Severity [CDEIS] score) and analysis of faecal microbiota composition.ResultsAt 8 weeks, clinical remission [HBI <5] was achieved in 13/13 patients on EEN and 5/6 patients on steroids; the mucosal healing rate was significantly higher in the EEN [89%] compared with steroid group [17%]. There were no significant differences between groups regarding biological markers, but the intestinal microbiota profiles shifted upon EEN-induced remission to a higher proportion of Ruminococcus bacteria compared with steroid-induced remission [p = 0.049], and with higher proportions of bacteria belonging to Clostridium in EEN-treated patients.ConclusionsBoth steroid and EEN induced clinical remission. However, patients with EEN-induced remission showed a higher rate of mucosal healing and this was associated with a different gut microbiota compositional shift in these children.

scholarly journals Exclusive Enteral Nutrition versus Infliximab in Inducing Therapy of Pediatric Crohn’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Youyou Luo ◽  
Jindan Yu ◽  
Jingan Lou ◽  
Youhong Fang ◽  
Jie Chen
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Adverse Effects ◽  
Enteral Nutrition ◽  
Clinical Symptoms ◽  
Activity Index ◽  
Group Versus ◽  
Disease Activity Index ◽  
Mucosal Healing ◽  
Exclusive Enteral Nutrition

Aim. To compare the effectiveness of exclusive enteral nutrition (EEN) and infliximab (IFX) therapy in pediatric Crohn’s disease (CD). Methods. In a prospective study of children initiating EEN or infliximab therapy for CD, we compared clinical outcomes using the pediatric Crohn’s disease activity index (PCDAI), growth improvement, endoscopic mucosal healing, and adverse effects. Data were measured at baseline and after 8 weeks of therapy. Results. We enrolled 26 children with CD; of whom, 13 were treated with infliximab, 13 with EEN. Clinical response (PCDAI) reduction ≥ 15 or final PCDAI ≤ 10 was achieved by 83.3% in the EEN group and 90.9% in the IFX group. Body mass index for age (BMIFA) z-scores were significantly increased in both groups (P<0.05). No significant differences were observed in PCDAI, height for age (HFA), or BMI recovery between two groups. Adverse effects were detected in 30.7% on infliximab and 0% on EEN. Mucosal healing was achieved in 71.4% cases in the EEN group versus 85.7% in the IFX group. Conclusion. EEN provided similar improvements as IFX in clinical symptoms, mucosal healing, and BMI. EEN therapy has less adverse effects when compared with IFX. This trial is registered with the Clinical Registration Number: ChiCTR-OON-17010834.

scholarly journals Toward Enteral Nutrition in the Treatment of Pediatric Crohn Disease in Canada: A Workshop to Identify Barriers and Enablers

2015 ◽  
Vol 29 (7) ◽  
pp. 351-356 ◽  
Author(s):  
Johan Van Limbergen ◽  
Jennifer Haskett ◽  
Anne M Griffiths ◽  
Jeff Critch ◽  
Hien Huynh ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Crohn Disease ◽  
Private Insurance ◽  
The United States ◽  
Normal Diet ◽  
Insurance Companies ◽  
Clinical Expertise ◽  
International Faculty ◽  
Exclusive Enteral Nutrition ◽  
First Choice

The treatment armamentarium in pediatric Crohn disease (CD) is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet]), which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn’s and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario), inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies). Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

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