Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, United Kingdom.
Department of Paediatric Gastroenterology, Hepatology and Nutrition, Royal Hospital for Children, Glasgow, United Kingdom.
Inflamm Bowel Dis. 2024 Aug 1;30(8):1258-1263. doi: 10.1093/ibd/izad167.
Exclusive enteral nutrition (EEN) is the recommended first-line induction treatment in pediatric patients with active luminal Crohn's disease (CD). We aimed to provide a nationwide overview of evolving EEN practices during an era of increasing biologic use.
We analyzed a prospectively identified nationwide cohort of newly diagnosed pediatric patients with CD in Scotland between January 1, 2015, and June 30, 2022. Patients who received EEN for any indication were divided into 6-monthly epochs and examined over time. Differences during the COVID-19 pandemic (March 16, 2020, to July 19, 2021) were examined. Data were retrospectively collected from electronic medical records: demographics, anthropometrics, concomitant treatments, aspects of EEN administration, and remission/response rates. Descriptive statistics and linear regression were used for analyses.
A total of 649 patients with CD were identified (63% male; median age 12.6 [interquartile range, 10.8-14.8] years); 497 (77%) of 649 received EEN as postdiagnosis induction therapy with a median course length of 7.7 (interquartile range, 5.9-8.0) weeks. Including repeat courses, 547 EEN courses were examined. An increasing incidence of CD was observed over time with no significant changes in EEN usage, remission or response rates, nasogastric tube usage, or course completion (all P > .05). Increasing use of EEN combined with biologics (combination induction) as first-line induction was observed over time (P < .001). Considering COVID-19, lower rates of EEN usage were observed (P = .008) with no differences in remission, oral administration, and course completion rates (all P > .05).
Over the past 7.5 years, except during the COVID-19 pandemic, EEN usage rates have not changed despite an increase in biologic use, although combination induction is an emerging trend.
在有症状的腔型克罗恩病（CD）患儿中，肠内营养（EEN）是推荐的一线诱导治疗方法。我们旨在提供一个在生物制剂应用日益增多的时代，EEN 应用演变的全国性概述。
我们分析了苏格兰在 2015 年 1 月 1 日至 2022 年 6 月 30 日期间，新诊断为 CD 的前瞻性识别的全国性儿科患者队列。因任何原因接受 EEN 的患者分为 6 个月的时期，并随时间进行检查。检查了 COVID-19 大流行期间（2020 年 3 月 16 日至 2021 年 7 月 19 日）的差异。数据从电子病历中回顾性收集：人口统计学、人体测量学、伴随治疗、EEN 管理的各个方面以及缓解/应答率。使用描述性统计和线性回归进行分析。
共确定了 649 例 CD 患者（63%为男性；中位年龄 12.6 [四分位间距，10.8-14.8] 岁）；649 例患者中有 497 例（77%）接受 EEN 作为诊断后诱导治疗，疗程中位数为 7.7（四分位间距，5.9-8.0）周。包括重复疗程，共检查了 547 个 EEN 疗程。随着时间的推移，CD 的发生率不断增加，但 EEN 的使用率、缓解或应答率、鼻胃管使用率或疗程完成率均无显著变化（均 P >.05）。随着时间的推移，EEN 联合生物制剂（联合诱导）作为一线诱导的使用率逐渐增加（P <.001）。考虑到 COVID-19，EEN 的使用率较低（P =.008），但缓解、口服给药和疗程完成率没有差异（均 P >.05）。
在过去的 7.5 年中，尽管生物制剂的应用有所增加，但除了 COVID-19 大流行期间，EEN 的使用率并没有改变，尽管联合诱导是一种新兴趋势。
