In the United States, about 3 million people are living with IBD, according to the Crohn’s & Colitis Foundation. And while Crohn’s is most often diagnosed in adults in their 20s or 30s, about 25 percent of people with IBD are diagnosed before age 20, according to an article published in November 2015 in the journal JAMA Pediatrics. Treatment options for children with Crohn’s disease vary and are based on the unique needs of your child. Conventional treatments can include corticosteroids, immunomodulators, and biologic drugs. Some people may be prescribed antibiotics, while others may require surgery to remove or repair damaged areas of their intestines. But another option that’s gaining attention in the medical community is exclusive enteral nutrition (EEN). This treatment involves taking a liquid formula instead of food for a defined period of time, with the goal of putting the disease in remission and improving other outcomes. “EEN provides a patient with her or his full caloric and nutrient needs, such as carbohydrates, fats, proteins, vitamins, and minerals,” explains Neera Gupta, MD, director of research at the pediatric inflammatory bowel disease center at Weill Cornell Medicine and NewYork–Presbyterian Hospital in New York City. A person’s energy and fluid requirements are used to determine the amount of formula consumed each day. EEN is administered at home and is usually given through a nasogastric tube, which delivers food and medicine to your stomach through your nose. The therapy typically lasts 6 to 12 weeks. In addition to increasing the likelihood of disease remission, EEN can also help heal the gastrointestinal tract and lead to weight gain, increased muscle mass, and improved bone health in children with Crohn’s, according to Boston Children’s Hospital.
How Effective Is a Liquid Diet for Crohn’s Disease in Children?
A number of studies have confirmed the benefits of EEN in children with Crohn’s disease. One research review, published in August 2017 in the journal Alimentary Pharmacology and Therapeutics, found that based on nine studies of EEN in children with Crohn’s, the treatment was just as effective as corticosteroids at inducing disease remission. What’s more, children who received EEN instead of corticosteroids were much more likely to experience intestinal healing. Any effective alternative to corticosteroids is worth considering because these drugs can lead to a number of troubling side effects in children, including reduced growth, worse bone health, and an increase in infections, according to study author Arun Swaminath, MD, director of the IBD program in the division of gastroenterology at Lenox Hill Hospital in New York City. Another study, published in May 2017 in the Journal of Crohn’s and Colitis, found that in a group of 127 children with Crohn’s disease, 87 percent of those who received EEN achieved remission after 4 to 12 weeks of therapy, compared with only 58 percent of those who received corticosteroids. What’s more, those who received EEN were less likely to need corticosteroids during a 6-year follow-up period. Researchers looked at a number of different outcomes in a comparison study of EEN and corticosteroids in children newly diagnosed with Crohn’s disease, published in March 2017 in the Journal of Crohn’s and Colitis. Not only was EEN better at inducing disease remission, it was also associated with healthier height growth. There was no difference in time to the next disease relapse or overall complication rates between the two groups over a 2-year period. While these results are certainly promising, more research is needed to determine if repeated EEN is an effective treatment for subsequent Crohn’s flares after an initial treatment, says Gupta.
Need for Greater Use of EEN to Treat Children With Crohn’s Disease
While EEN therapy is fairly common in Europe, it’s been slower to catch on in the United States. But since clinical guidelines — published in October 2014 in the Journal of Crohn’s and Colitis — recommended EEN as the first-line therapy for inducing remission in children with Crohn’s, the treatment may be gaining in popularity. In the United States, Swaminath says, finding a gastroenterologist who offers ENN can still sometimes be tough. “Once you head away from specialized IBD centers, the knowledge and effective implementation of this nutritional therapy generally drops off,” he laments. But he’s hopeful that the results of his 2017 study, and others like it, are turning the tide. Studies on EEN in recent years “give more support to patients and physicians who advocate nutritional therapy over steroids,” Swaminath notes. Gupta agrees that the results of newer studies “should be used to encourage pediatric gastroenterologists to offer EEN, and encourage patients and families to choose this treatment in appropriate situations.” That means it’s appropriate for parents to ask about EEN at an appointment, and even to seek out a doctor who offers it as a therapy. Ultimately, the most important thing, Gupta says, is for parents of children with Crohn’s “to discuss with their pediatric gastroenterologist whether or not EEN is the right choice for the child, for her or his specific situation.” Additional reporting by Quinn Phillips
