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Moriczi M, Pujol-Muncunill G, Martín-Masot R, Jiménez Treviño S, Segarra Cantón O, Ochoa Sangrador C, Peña Quintana L, González Santana D, Rodríguez Martínez A, Rosell Camps A, Armas H, Barrio J, González de Caldas R, Rodríguez Salas M, Balmaseda Serrano E, Donat Aliaga E, Bodas Pinedo A, Vaquero Sosa E, Vecino López R, Solar Boga A, Moreno Álvarez A, Sánchez Sánchez C, Tolín Hernani M, Gutiérrez Junquera C, Martinón Torres N, Leis Trabazo MR, Eizaguirre FJ, García Peris M, Medina Benítez E, Fernández Caamaño B, Vegas Álvarez AM, Crespo Valderrábano L, Alonso Vicente C, Rubio Santiago J, Galera-Martínez R, García-Romero R, Ros Arnal I, Fernández Cebrián S, Lorenzo Garrido H, Viada Bris JF, Velasco Rodríguez-Belvis M, Bartolomé Porro JM, Blanco Rodríguez M, Barros García P, Botija G, Chicano Marín FJ, La Orden Izquierdo E, Crehuá-Gaudiza E, Navas-López VM, Martín-de-Carpi J. Predictors of Response to Exclusive Enteral Nutrition in Newly Diagnosed Crohn´s Disease in Children: PRESENCE Study from SEGHNP. Nutrients 2020; 12:nu12041012. [PMID: 32272604 PMCID: PMC7231252 DOI: 10.3390/nu12041012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/21/2022] Open
Abstract
Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing in children with Crohn´s disease (CD) without the adverse effects of these drugs. The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in children newly diagnosed with CD, to describe the predictive factors of response to EEN and the need for treatment with biological agents during the first 12 months of the disease. We conducted an observational retrospective multicentre study that included paediatric patients newly diagnosed with CD between 2014–2016 who underwent EEN. Two hundred and twenty-two patients (140 males) from 35 paediatric centres were included, with a mean age at diagnosis of 11.6 ± 2.5 years. The median EEN duration was 8 weeks (IQR 6.6–8.5), and 184 of the patients (83%) achieved clinical remission (weighted paediatric Crohn’s Disease activity index [wPCDAI] < 12.5). Faecal calprotectin (FC) levels (μg/g) decreased significantly after EEN (830 [IQR 500–1800] to 256 [IQR 120–585] p < 0.0001). Patients with wPCDAI ≤ 57.5, FC < 500 μg/g, CRP >15 mg/L and ileal involvement tended to respond better to EEN. EEN administered for 6–8 weeks is effective for inducing clinical remission. Due to the high response rate in our series, EEN should be used as the first-line therapy in luminal paediatric Crohn’s disease regardless of the location of disease and disease activity.
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Affiliation(s)
- Melinda Moriczi
- Paediatric Gastroenterology and Nutrition Unit, Hospital Complex Torrecárdenas, 04009 Almeria, Spain; (M.M.); (R.G.-M.)
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Esplugues del Llobregat, 08950 Barcelona, Spain; (G.P.-M.); (J.M.-d.-C.)
| | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Malaga, 29011 Málaga, Spain;
| | - Santiago Jiménez Treviño
- Gastroenterology Unit, Hepatology and Nutrition, Central University Hospital of Asturias, 33011 Oviedo, Spain;
| | - Oscar Segarra Cantón
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Vall d’Hebron, 08035 Barcelona, Spain;
| | - Carlos Ochoa Sangrador
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Virgen de la Concha, 49022 Zamora, Spain;
| | - Luis Peña Quintana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital, 35016 Las Palmas of Gran Canaria, Spain; (L.P.Q.); (D.G.S.)
| | - Daniel González Santana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital, 35016 Las Palmas of Gran Canaria, Spain; (L.P.Q.); (D.G.S.)
| | | | - Antonio Rosell Camps
- Paediatric Gastroenterology and Nutrition Unit, University Hospital Son Espases, 07010 Palma de Mallorca, Spain;
| | - Honorio Armas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital of the Canary Islands, 38320 Tenerife, Spain;
| | - Josefa Barrio
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Fuenlabrada, Fuenlabrada, 28942 Madrid, Spain;
| | - Rafael González de Caldas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Reina Sofía, 14004 Cordoba, Spain; (R.G.d.C.); (M.R.S.)
| | - Mónica Rodríguez Salas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Reina Sofía, 14004 Cordoba, Spain; (R.G.d.C.); (M.R.S.)
| | - Elena Balmaseda Serrano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Complex, University of Albacete, 02008 Albacete, Spain;
| | - Ester Donat Aliaga
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital La Fe, 46009 Valencia, Spain;
| | - Andrés Bodas Pinedo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Esther Vaquero Sosa
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Raquel Vecino López
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clinic San Carlos, 28040 Madrid, Spain; (A.B.P.); (E.V.S.); (R.V.L.)
| | - Alfonso Solar Boga
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital Teresa Herrera, 15004 A Coruña, Spain; (A.S.B.); (A.M.Á.)
| | - Ana Moreno Álvarez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Maternal-Child Hospital Teresa Herrera, 15004 A Coruña, Spain; (A.S.B.); (A.M.Á.)
| | - César Sánchez Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, General University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.S.S.); (M.T.H.)
| | - Mar Tolín Hernani
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, General University Hospital Gregorio Marañón, 28009 Madrid, Spain; (C.S.S.); (M.T.H.)
| | - Carolina Gutiérrez Junquera
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Puerta de Hierro, 28220 Majadahonda, Madrid, Spain;
| | - Nazareth Martinón Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Clinic of Santiago, 15706 Santiago de Compostela, Spain; (N.M.T.); (M.R.L.T.)
| | - María Rosaura Leis Trabazo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Clinic of Santiago, 15706 Santiago de Compostela, Spain; (N.M.T.); (M.R.L.T.)
| | - Francisco Javier Eizaguirre
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital of Donostia, 20006 San Sebastian, Spain;
| | - Mónica García Peris
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Lluís Alcanyís, Xátiva, 46800 Valencia, Spain;
| | - Enrique Medina Benítez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Beatriz Fernández Caamaño
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Álvaro Cunqueiro, 36213 Vigo, Spain;
| | - Ana María Vegas Álvarez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Laura Crespo Valderrábano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Carmen Alonso Vicente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Río Hortega, 47012 Valladolid, Spain; (A.M.V.Á.); (L.C.V.); (C.A.V.)
| | - Javier Rubio Santiago
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Jerez, 11408 Jerez de la Frontera, Cádiz, Spain;
| | - Rafael Galera-Martínez
- Paediatric Gastroenterology and Nutrition Unit, Hospital Complex Torrecárdenas, 04009 Almeria, Spain; (M.M.); (R.G.-M.)
| | - Ruth García-Romero
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Paediatric Hospital Miguel Servet, 50009 Zaragoza, Spain; (R.G.-R.); (I.R.A.)
| | - Ignacio Ros Arnal
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Paediatric Hospital Miguel Servet, 50009 Zaragoza, Spain; (R.G.-R.); (I.R.A.)
| | - Santiago Fernández Cebrián
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Complex Ourense, 32616 Ourense, Spain;
| | - Helena Lorenzo Garrido
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Basurto, Bilbao, 48013 Vizcaya, Spain;
| | - Javier Francisco Viada Bris
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Niño Jesús, 28009 Madrid, Spain; (J.F.V.B.); (M.V.R.-B.)
| | - Marta Velasco Rodríguez-Belvis
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Niño Jesús, 28009 Madrid, Spain; (J.F.V.B.); (M.V.R.-B.)
| | | | - Miriam Blanco Rodríguez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Jiménez Díaz Foundation, 28040 Madrid, Spain;
| | - Patricia Barros García
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital San Pedro de Alcántara, 10003 Cáceres, Spain;
| | - Gonzalo Botija
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Alcorcón Foundation, 28922 Alcorcón, Madrid, Spain;
| | - Francisco José Chicano Marín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Los Arcos del Mar Menor, 30739 Pozo Aledo, Murcia, Spain;
| | - Enrique La Orden Izquierdo
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Hospital Infanta Sofía, 28709 San Sebastián de los Reyes, Madrid, Spain;
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, University Clinical Hospital, 46010 Valencia, Spain;
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Regional University Hospital of Malaga, 29011 Málaga, Spain;
- Institute of Biomedical Research in Malaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-292-191
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, Esplugues del Llobregat, 08950 Barcelona, Spain; (G.P.-M.); (J.M.-d.-C.)
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