Differences in outcomes over time with exclusive enteral nutrition compared to steroids in children with mild to moderate Crohn's Disease: results from the GROWTH CD study

Abstract

Background: Exclusive enteral nutrition (EEN) and corticosteroids (CS) both induce similar rates of remission in mild to moderate pediatric Crohn's disease (CD), but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long term outcomes. Methods: We prospectively followed newly diagnosed children <17 years with mild to moderate disease at baseline for two years in the GROWTH CD study. Patients were evaluated at baseline and at 8, 12, 78, and 104 weeks. Remission, relapses, complications (fibrostenotic, penetrating disease, and active perianal disease) and growth were recorded throughout the study. A propensity score analysis was performed. Results: 147 children (mean age 12.9+/-3.2 years), treated by EEN (n=60) or CS (n=87) were included. New complications developed in 13.7% of CS (12/87) versus 11.6% of EEN (7/60), p=0.29. Remission was achieved in 41/87 (47%) in CS and 38/60 (63%) EEN, p=0.036. Median time to relapse did not differ (14.4+/-1 months with CS, 16.05+/-1.1 EEN, p=0.28). Mean height Z scores decreased from week 0 to week 78 with CS (-0.34+/-1.1 to -0.51+/-1.2, p=0.01), but not with EEN (-0.32+/- 1.1 to -0.22+/- 0.9 p=0.56). In a propensity score analysis, EEN was superior to CS for inducing remission (p=0.05) and trended to superiority for height Z score (p=0.055). Conclusions: Use of EEN was associated with higher remission rates and a trend toward better growth but similar relapse and complication rates in new onset mild to moderate paediatric CD.