Use of Enteral Nutrition for the Control of Intestinal Inflammation in Pediatric Crohn Disease

Division of Gastroenterology, Janeway Children's Health Center, Memorial University, St John's, Newfoundland and Labrador, Canada.
Journal of pediatric gastroenterology and nutrition (Impact Factor: 2.63). 02/2012; 54(2):298-305. DOI: 10.1097/MPG.0b013e318235b397
Source: PubMed

ABSTRACT Exclusive enteral nutrition is an effective yet often underused therapy for the induction of remission in pediatric Crohn disease. The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition formed the Enteral Nutrition Working Group to review the use of enteral nutrition therapy in pediatric Crohn disease. The group was composed of 5 pediatric gastroenterologists and 1 pediatric nutritionist, all with an interest and/or expertise in exclusive enteral nutrition. Specific attention was placed upon review of the evidence for efficacy of therapy, assessment of the variations in care, identification of barriers to its widespread use, and compilation of the necessary components for a successful program. The present guideline is intended to aid physicians in developing an enteral nutrition therapy program and potentially promote its use.

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    • "Generally, when considering medical nutrition interventions, clinical evidence of their efficacy in supporting the recovery of patients has been demonstrated for different disease areas (for example, in critically ill patients,7,8 pancreatitis,9 and patients suffering from dysphagia10). Similarly, in pediatric Crohn’s disease patients, the use of enteral nutrition during flare-ups of the disease has been shown to induce remission as effectively as corticosteroids, and even more safely.11 Furthermore, the clinical evidence for the efficacy of medical nutrition in supporting the recovery of patients with disease-related malnutrition has been extensively documented, and it has shown a reduction in mortality, morbidity, as well as in the length of hospitalization and rehospitalizations.12 "
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    ABSTRACT: Health care decision-makers have begun to realize that medical nutrition plays an important role in the delivery of care, and it needs to be seen as a sole category within the overall health care reimbursement system to establish the value for money. Indeed, improving health through improving patients' nutrition may contribute to the cost-effectiveness and financial sustainability of health care systems. Medical nutrition is regulated by a specific bill either in Europe or in the United States, which offers specific legislations and guidelines (as provided to patients with special nutritional needs) and indications for nutritional support. Given that the efficacy of medical nutrition has been proven, one can wonder whether the heterogeneous nature of its coverage/reimbursement across countries might be due to the lack of health-related economic evidence or value-for-money of nutritional interventions. This paper aims to address this knowledge gap by performing a systematic literature review on health economics evidence regarding medical nutrition, and by summarizing the results of these publications related to the value for money of medical nutrition interventions.
    ClinicoEconomics and Outcomes Research 05/2014; 6(1):241-252. DOI:10.2147/CEOR.S58852
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    • "The choice of formula is probably also dictated by clinician experience, funding, and local availability [38]. There are no controlled trials that have studied the appropriate length of treatment, but current practice appears to be based on most studies reporting the occurrence of clinical remission within this period [35] [36] [38]. Small amounts of water or beverages are allowed in this period. "
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    ABSTRACT: This paper reviews the literature on the history, efficacy, and putative mechanism of action of enteral nutrition for inflammatory bowel disease in both paediatric and adult patients. It also analyses the reasoning behind the low popularity of exclusive enteral nutrition in clinical practice despite the benefits and safety profile.
    Gastroenterology Research and Practice 12/2013; 2013(4):482108. DOI:10.1155/2013/482108 · 1.75 Impact Factor
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    ABSTRACT: Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's disease patients endoscopy was performed to assess disease activity in the rectum. Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001). Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound elastography in inflammatory bowel disease.
    BMC Gastroenterology 10/2011; 11(1):113. DOI:10.1186/1471-230X-11-113 · 2.37 Impact Factor
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