Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn's disease: a meta-analysis

Abstract

Background: Many studies have examined the effects of exclusive enteral nutrition (EEN) in children with Crohn's disease (CD), but corticosteroids are considered a superior therapy and are frequently used in China. This meta-analysis aims to compare the efficacy of EEN with corticosteroids in treating pediatric CD.

Methods: A comprehensive retrieval from medical databases, including PubMed, EMBASE, MEDLINE, Web of Science, Wanfang data, VIP and CNKI, was performed using the search terms "diet therapy", "exclusive enteral nutrition", "Crohn's disease", "inflammatory bowel diseases", "child" and "pediatrics" from January 1990 to April 2017.

Results: We included 18 studies from 1329 identified sources in this meta-analysis. EEN was as effective as corticosteroids in inducing remission rate of children suffering from CD (OR = 1.35; 95% CI 0.90, 2.10; P = 0.14). Nevertheless, patients who received EEN were more likely to achieve both endoscopic mucosal healing (OR = 5.24; 95% CI 2.06, 13.37; P = 0.0005) and histological mucosal healing (OR = 4.78; 95% CI 1.89, 12.08; P = 0.0009) than those who received corticosteroids; the Pediatric Crohn's Disease Activity Index was lower [mean difference (MD) = - 3.67; 95% CI - 4.91, - 2.43] and weight gain was higher (MD = 1.92; 95% CI 0.02, 3.83; P = 0.05) in those patients who received EEN than in those who received corticosteroids. No difference was found in relapse rate (OR = 0.57; 95% CI 0.25, 1.29; P = 0.18), height for age or body mass index between the patients treated with EEN and corticosteroids at the 1-year end point.

Conclusions: This meta-analysis reveals that there is no significant difference between EEN and corticosteroids in the efficacy of inducing remission rate of CD in a pediatric population, but EEN is superior to corticosteroids in improving short-term mucosal inflammation and reducing the PCDAI index.

Keywords: Children; Corticosteroids; Crohn’s disease; Exclusive enteral nutrition; Inflammatory bowel disease; Nutrition.

Fig. 1

Flow diagram of trials for inclusion in the systematic review. n number of records

Fig. 2

Forest plot for the comparison of induced remission rates between EEN versus corticosteroids for pediatric Crohn’s disease. No significant difference in induced remission rates was found between the EEN and corticosteroid groups (OR = 1.35; 95% CI 0.90, 2.10; P = 0.14). EEN exclusive enteral nutrition, OR odds ratio, CI confidence interval, df degree of freedom

Fig. 3

Forest plot for the comparison of 1-year relapse rates between EEN versus corticosteroids for pediatric Crohn’s disease. No significant difference in 1-year relapse rates was found between the EEN and corticosteroids groups (OR = 0.57; 95% CI 0.25, 1.29; P = 0.18). EEN exclusive enteral nutrition, OR odds ratio, CI confidence interval, df degree of freedom

Fig. 4

Forest plot for the comparison of mucosal healing between EEN versus corticosteroids for pediatric Crohn’s disease. A significant difference both in endoscopic and histological mucosal healing was found between the EEN and corticosteroid groups (OR = 5.24 0, 95% CI 2.06, 13.37; P = 0.0005 and OR = 4.78 0, 95% CI 1.89, 12.08; P = 0.0009, respectively). EEN exclusive enteral nutrition, OR odds ratio, CI confidence interval, df degree of freedom

Fig. 5

Forest plot for the comparison of PCDAI between EEN versus corticosteroids for pediatric Crohn’s disease. A significant difference in PCDAI was found between the EEN and corticosteroid groups with a standard mean difference of − 3.67 (95% CI − 4.91, − 2.43; P < 0.00001). PCDAI Pediatric Crohn’s Disease Activity Index, EEN exclusive enteral nutrition, CI confidence interval, df degree of freedom