Berni Canani R, Terrin G, Borrelli O, Romano M T, Manguso F, Coruzzo A, D'Armiento F, Romeo E F, Cucchiara S
Department of Paediatrics, University of Naples Federico II, Naples, Italy.
Dig Liver Dis. 2006 Jun;38(6):381-7. doi: 10.1016/j.dld.2005.10.005. Epub 2005 Nov 18.
Comparative data on the therapeutic efficacy of different enteral nutrition formulas and corticosteroids to obtain clinical remission and to induce mucosal healing influencing long-term disease course in paediatric Crohn's disease are still scarce.
To investigate the efficacy of nutritional therapy using three different formulas versus corticosteroids to achieve clinical remission as well as to induce intestinal mucosal healing in active Crohn's disease children. Duration of remission and effect on growth recovery were also assessed.
Clinical, laboratory, endoscopic and histological data of all new diagnosed active Crohn's disease paediatric cases were retrospectively recorded and reviewed. Thirty-seven children (median age 12.1 years) received nutritional therapy (12 polymeric; 13 semi-elemental; 12 elemental diet) and 10 subjects (median age 12.4 years) received corticosteroids.
Similar clinical remission rate were observed after 8 weeks of treatment: 86.5% children receiving nutritional therapy versus 90% treated with corticosteroids. Improvement in mucosal inflammation occurred in 26 out of 37 (64.8%) patients on nutritional therapy and in 4 out of 10 (40%) children on steroids (p < 0.05). Finally, seven subjects on nutritional therapy and none on corticosteroids achieved complete mucosal healing (p < 0.005) at the end of the treatment. Nutritional therapy was more effective than corticosteroids in improving nutritional status and linear growth recovery. Compared to corticosteroids, the duration of clinical remission was longer in the nutritional therapy groups without differences among the three different formulas.
In children with active Crohn's disease, nutritional therapy is more effective than corticosteroids to improve intestinal inflammation and to maintain a more sustained clinical remission.
关于不同肠内营养配方和皮质类固醇在小儿克罗恩病中实现临床缓解、诱导黏膜愈合以及影响长期病程的治疗效果的比较数据仍然匮乏。
研究使用三种不同配方的营养疗法与皮质类固醇相比，在活动性克罗恩病患儿中实现临床缓解以及诱导肠道黏膜愈合的疗效。还评估了缓解期的持续时间以及对生长恢复的影响。
回顾性记录并分析所有新诊断的活动性克罗恩病儿科病例的临床、实验室、内镜和组织学数据。37名儿童（中位年龄12.1岁）接受营养治疗（12名接受整蛋白型；13名接受半要素型；12名接受要素饮食），10名受试者（中位年龄12.4岁）接受皮质类固醇治疗。
治疗8周后观察到相似的临床缓解率：接受营养治疗的儿童为86.5%，接受皮质类固醇治疗的儿童为90%。营养治疗组37名患者中有26名（64.8%）黏膜炎症得到改善，接受类固醇治疗的10名儿童中有4名（40%）黏膜炎症得到改善（p<0.05）。最后，治疗结束时，7名接受营养治疗的受试者实现了完全黏膜愈合，而接受皮质类固醇治疗的受试者无一实现完全黏膜愈合（p<0.005）。营养治疗在改善营养状况和线性生长恢复方面比皮质类固醇更有效。与皮质类固醇相比，营养治疗组的临床缓解期更长，三种不同配方之间无差异。
在活动性克罗恩病患儿中，营养治疗在改善肠道炎症和维持更持久的临床缓解方面比皮质类固醇更有效。
