Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Department NEUROFARBA, University of Florence, Florence, Italy.
J Pediatr Gastroenterol Nutr. 2024 Sep;79(3):592-601. doi: 10.1002/jpn3.12283. Epub 2024 Jul 4.
We aimed to appraise the real-life efficacy of Crohn's disease exclusion diet (CDED) coupled with partial enteral nutrition (PEN) in inducing clinical and biochemical remission at disease onset and in patients with loss of response to biologics and immunomodulators.
We retrospectively gathered data of patients aged less than 18 years of age with a diagnosis of Crohn's disease (CD), who received CDED coupled with PEN at a tertiary level pediatric inflammatory bowel disease center.
Sixty-six patients were identified. Forty (60.6%) started CDED plus PEN at disease onset and 26 (39.4%) received CDED with PEN as add-on therapy. Forty-six (69.7%) patients achieved clinical remission (weighted Pediatric Crohn's Disease Activity Index < 12.5) at the end of phase 1, 44 (66.7%) normalized c-reactive protein levels (<0.5 mg/dL) and 18 (27.2%) patients normalized calprotectin levels (<150 µg/g). Nine of 19 (47.3%) of patients with clinically severe disease (defined by Physician Global Assessment) achieved clinical remission at the end of phase I. Patients with extraintestinal manifestations had statistically lower clinical response rates to the dietary regimen (p = 0.018). Among patients who received CDED + PEN as add-on treatment, a previous successful course of Exclusive Enteral Nutrition was associated with statistically higher clinical remission rates at Week 8 (p = 0.026). Clinical response at Week 4 was an independent predictor of clinical remission and fecal calprotectin normalization at Week 8 (p = 0.002).
CDED with PEN confirmed its efficacy in a real-life setting, proving to be effective also in refractory patients and those with severe disease. Early clinical response predicts clinical remission at the end of phase 1.
本研究旨在评估克罗恩病排除饮食（CDED）联合部分肠内营养（PEN）在诱导疾病初发患者和生物制剂及免疫调节剂应答失败患者临床和生化缓解方面的实际疗效。
我们回顾性收集了一家三级儿科炎症性肠病中心的年龄小于 18 岁克罗恩病（CD）患者的数据，这些患者接受了 CDED 联合 PEN 治疗。
共鉴定出 66 例患者。其中 40 例（60.6%）在疾病初发时开始接受 CDED 联合 PEN 治疗，26 例（39.4%）接受 CDED 联合 PEN 作为附加治疗。第 1 阶段结束时，46 例（69.7%）患者达到临床缓解（加权儿科克罗恩病活动指数<12.5），44 例（66.7%）患者 C-反应蛋白水平正常（<0.5mg/dL），18 例（27.2%）患者钙卫蛋白水平正常（<150μg/g）。第 1 阶段结束时，9 例（47.3%）临床严重疾病（根据医生总体评估定义）患者达到临床缓解。有肠外表现的患者对饮食方案的临床反应率较低（p=0.018）。在接受 CDED+PEN 附加治疗的患者中，之前成功接受过完全肠内营养的患者在第 8 周时临床缓解率更高（p=0.026）。第 4 周的临床反应是第 8 周临床缓解和粪便钙卫蛋白正常化的独立预测因子（p=0.002）。
CDED 联合 PEN 在真实环境中证实了其疗效，在难治性患者和病情严重的患者中也同样有效。早期临床反应可预测第 1 阶段结束时的临床缓解。
