Laurie Barclay, MD

NEW YORK (MedscapeWire) May 21 — Nutritional therapy achieves better long-term outcome than steroids in children with active Crohn's disease, according to 2 studies presented May 19 and 21 at the Digestive Disease Week annual meeting in San Francisco, California.

"In children with Crohn's disease, clinical trials have demonstrated that polymeric or elemental diet therapy is as effective as steroids in inducing remission, whilst avoiding steroid side effects," write Bhupinder Sandhu and colleagues from Bristol, England.

Of 44 children (median age at diagnosis of Crohn's disease, 12.8 years) elemental diet therapy induced clinical remission in 40 (90%). Median time to remission was 6 weeks (range, 2-12 weeks), and median duration of first remission was 54 weeks (range, 4-312 weeks). At follow-up, 17 children (38%) had not relapsed, and the remaining 27 children suffered a total of 52 relapses. Of 16 children whose relapses were treated with elemental diet therapy, 12 (75%) went into remission.

"This data suggests that there are significant long-term benefits to using elemental diet therapy as first-line therapy for Crohn's disease," the authors write. "Steroids may be avoided in nearly half the cases, or their use postponed by 68 weeks."

In a second study from Naples and Rome, Italy, 37 patients, aged 7 to 16 years, with active Crohn's disease received nutritional therapy, while 10 comparable patients received methylprednisolone, 2 mg/kg/day for 4 weeks, with subsequent tapering over at least 4 weeks. Nutritional therapy included polymeric diet given orally and semielemental or elemental diet formulae infused with a pump through a nasogastric tube.

Within 8 weeks of treatment, 32 of the 37 children assigned to nutritional therapy and 9 of the 10 given steroids went into clinical remission. Mean time elapsed to achieve remission was 2.5 weeks for those on nutritional therapy and 3.7 weeks for those on steroids (P<.05). Seven patients on nutritional therapy and none on steroids showed complete mucosal healing (P<.005).

"In children with active Crohn's disease, exclusive nutritional therapy shows a more rapid effect than steroids in inducing clinical remission and is markedly more effective than steroids in producing healing of mucosal inflammation," write Roberto B. Canani and colleagues. "Nutritional therapy alone is the preferred form of therapy for children with active Crohn's disease."

DDW Annual Meeting: Abstracts 103976, 107178. May 19 and 21, 2002.

Reviewed by Gary D. Vogin, MD

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Digestive Disease Week 2002

 

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