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Wasilewska A, Tomasik P, Gałaś A, Stochel-Gaudyn A, Drożdż D, Fyderek K, Sładek M. Bioimpedance Phase Angle as a Diagnostic Tool of Nutritional Status in Children with Crohn's Disease on Exclusive Enteral Nutrition Therapy: One-Year Follow-Up Study. J Med Food 2025; 28:501-507. [PMID: 40178970 DOI: 10.1089/jmf.2023.0242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
Exclusive enteral nutrition (EEN) is highly effective in achieving remission and improving nutritional status in pediatric Crohn's disease (CD), commonly associated with altered body mass composition (BC). Bioimpedance analysis (BIA) with phase angle (PA) assessment is a noninvasive, reliable tool in screening for BC alterations. In the present study we aimed to assess the PA's usefulness in the detection of malnutrition in newly diagnosed pediatric CD, ongoing EEN treatment, and during 1-year follow-up. Patients and study design: Fourty-three patients with CD, qualified for EEN, were enrolled in the study. Additionally, 22 healthy children, being in the same age category, served as controls. Fat-free mass (FFM), fat-free mass index (FFMI), and BIA-derived PA were assessed at diagnosis, after EEN completion, and at week 52. The same parameters were obtained in the control group once. The majority of patients presented with normal body mass index at diagnosis. PA values were lower than 5 degrees in 65% of the study group. FFMI deficiencies were observed in 74% of patients. After EEN completion, an increase in FFM (P < .001) was observed. The highest mean of FFM (P < .001) and PA (P < .001) were observed at week 52. A strong correlation between PA and FFM at CD diagnosis (Spearman's rho = 0.671, r = 0.702, P < .001), after EEN completion (Spearman's rho = 0.781, P < .00) and at week 52 (Spearman's rho = 0.657, P < .001) was present. PA has been observed as positively associated with albumin concentrations both at diagnosis and after EEN. Our study provides some support that PA may be a reliable tool for screening alteration in BC, especially FFM and lean tissue mass (LTM). Moreover, PA has been observed as positively associated with albumin levels at CD diagnosis, which provides some evidence that it may be considered as a risk indicator of malnutrition and protein deficiency in newly diagnosed CD pediatric patients.
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Affiliation(s)
- Agata Wasilewska
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| | - Przemysław Tomasik
- Department of Clinical Biochemistry University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow, Poland
| | - Aleksander Gałaś
- Department of Epidemiology and Preventive Medicine, Faculty of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Stochel-Gaudyn
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, University Children's Hospital in Cracow, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Fyderek
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
| | - Małgorzata Sładek
- Department of Pediatrics, Gastroenterology and Nutrition, University Children's Hospital in Cracow, Jagiellonian University Medical College, Cracow Poland
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Chu MKW, Day AS, Broad L, Costello SP, Edwards S, Bryant RV. Meta-Analysis: Exclusive Enteral Nutrition in Adults With Ulcerative Colitis. Aliment Pharmacol Ther 2025; 61:756-775. [PMID: 39817370 PMCID: PMC11825926 DOI: 10.1111/apt.18495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 10/15/2024] [Accepted: 12/31/2024] [Indexed: 01/18/2025]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is an established dietary therapy for Crohn's disease but its role in ulcerative colitis remains unclear. AIMS To investigate the efficacy of EEN in adults with active ulcerative colitis and compare variations in treatment protocols, safety, tolerability and adherence. METHODS We conducted a systematic search of MEDLINE, Embase, Cochrane CENTRAL, Emcare, CINAHL, Web of Science and trial registries for articles published from inception until July 21, 2024. We included all experimental and observational studies that described the use of EEN in adults with active ulcerative colitis. This review was registered on PROSPERO (CRD42022319584). RESULTS Of 3273 articles screened, we included 10 studies (334 adults). Overall, there was no difference between EEN and comparator for ulcerative colitis remission induction (median follow-up 14 days, risk ratio (RR) 1.15, 95% confidence interval (CI) 0.71-1.85; 2 studies). In acute severe ulcerative colitis, there was no difference between EEN and comparator for corticosteroid failure (RR 0.76, 95% CI 0.48-1.20; 2 studies) or risk of colectomy (RR 0.88, 95% CI 0.51-1.51, n = 2 studies) during index admission. The pooled discontinuation rate was 3% (95% CI 0-10; 9 studies). There was heterogeneity in trial design, methodology and assessment of outcomes. CONCLUSION EEN was well tolerated with low therapy discontinuation in adults with active ulcerative colitis. However, there is insufficient evidence to support the use of EEN as an adjunctive therapy to standard of care. Further, well-designed studies with reproducible methodology and endpoints are necessary to evaluate its effectiveness. REGISTRY NUMBER FOR SYSTEMATIC REVIEW PROSPERO 2022 CRD42022319584.
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Affiliation(s)
- Matthew K. W. Chu
- School of Medicine, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease ServiceThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease Research GroupThe Basil Hetzel Institute for Translational Health ResearchAdelaideSouth AustraliaAustralia
| | - Alice S. Day
- School of Medicine, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease ServiceThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease Research GroupThe Basil Hetzel Institute for Translational Health ResearchAdelaideSouth AustraliaAustralia
- Nutrition & Dietetics DepartmentCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Lani Broad
- Nutrition & Dietetics DepartmentCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
| | - Samuel P. Costello
- School of Medicine, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease ServiceThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease Research GroupThe Basil Hetzel Institute for Translational Health ResearchAdelaideSouth AustraliaAustralia
| | - Suzanne Edwards
- School of Public HealthThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Robert V. Bryant
- School of Medicine, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease ServiceThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- Inflammatory Bowel Disease Research GroupThe Basil Hetzel Institute for Translational Health ResearchAdelaideSouth AustraliaAustralia
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Bhalla A, Shahi A, Maity M, Safa F, Srividya V, Clementina R, Anugu GR, Younas S. Inflammatory Bowel Disease in Children: Current Diagnosis and Treatment Strategies. Cureus 2025; 17:e78462. [PMID: 40051947 PMCID: PMC11883196 DOI: 10.7759/cureus.78462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2025] [Indexed: 03/09/2025] Open
Abstract
Pediatric inflammatory bowel disease (PIBD), including Crohn's disease and ulcerative colitis, has emerged as a significant global health challenge with rising incidence rates. Unlike adult inflammatory bowel disease, PIBD presents complexities, including growth impairment, nutritional deficiencies, and psychosocial challenges that necessitate tailored management strategies. This article reviews current diagnostic and emerging treatment strategies to highlight the evolution from traditional therapies such as aminosalicylates, corticosteroids, and immunomodulators to advanced biologic agents like infliximab and adalimumab. Emerging biological therapies, including vedolizumab and ustekinumab, show promise, while novel small molecule therapies such as Janus kinase (JAK) inhibitors are under investigation for potential use in the pediatric population. Supportive treatments, including exclusive enteral nutrition, modified diets, and probiotics, play a critical role in comprehensive disease management. Stem cell therapy and fecal microbiota transplant represent innovative approaches still under clinical evaluation. The review underscores the significance of holistic care, incorporating mind-body interventions and psychosocial support to improve patient quality of life. Key challenges persist, such as infection risks associated with long-term biological therapy use, gaps in pediatric-specific guidelines, and the limited inclusion of children in clinical trials. Future recommendations emphasize the importance of structured transition programs bridging pediatric and adult care, regular updates to clinical guidelines, and the integration of precision medicine to personalize treatment plans. Continued research and collaboration are essential for advancing the understanding and management of PIBD, ensuring that pediatric patients benefit from the most effective, evidence-based care available.
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Affiliation(s)
- Akshita Bhalla
- Internal Medicine, Punjab Institute of Medical Sciences, Jalandhar, IND
| | - Anushka Shahi
- Internal Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, IND
| | - Madhurima Maity
- Critical Care Medicine, Sir H.N Reliance Foundation Hospital, Mumbai, IND
| | - Fnu Safa
- Internal Medicine, Osmania Medical College, Hyderabad, IND
| | | | | | | | - Salma Younas
- Pharmacy, Punjab University College of Pharmacy, Lahore, PAK
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El-Shafie S, Metwaly A. Diet-specific impacts on the gut microbiome and their relation to health and inflammation. NUTRITION IN THE CONTROL OF INFLAMMATION 2025:77-124. [DOI: 10.1016/b978-0-443-18979-1.00005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Liao S, Wang B, Zheng Z, Ye S, Huang L, Zheng Y. Therapeutic Value of Exclusive and Partial Enteral Nutrition in Adult Patients with Moderate to Severe Crohn's Disease with Ustekinumab for Induction of Remission. Niger J Clin Pract 2024; 27:1399-1404. [PMID: 40033533 DOI: 10.4103/njcp.njcp_563_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 10/08/2024] [Indexed: 03/05/2025]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic, nonspecific transmural inflammatory bowel disease. Enteral nutrition (EN) is a vital adjunctive treatment for CD; however, its precise therapeutic role remains unknown. AIMS This study aims to investigate the therapeutic value of exclusive enteral nutrition (EEN) and partial enteral nutrition (PEN) in moderate to severe CD in adults induced by ustekinumab (UST). METHODS This retrospective analysis included 50 adult patients with moderate to severe CD who achieved remission wish UST therapy. Patients were divided into the EEN group (n = 24) and the PEN group (n = 26) based on their mode of EN. The dosage of UST for intravenous infusion was weight-based, followed by a subcutaneous injection of 90 mg UST as induction therapy 8 weeks after the first administration. We compared the clinical remission rate, endoscopic remission rates, body mass index (BMI), nutritional indicators, and inflammatory markers between the two groups after 8 weeks of treatment. RESULTS After treatment, both the Crohn's Disease Activity Index and Crohn's Disease Endoscopic Index of Severity decreased in both groups, with the EEN group showing significantly higher clinical and endoscopic remission rates than the PEN group (P < 0.05). Both groups also exhibited a significant increase in BMI and nutritional indicators after treatment, with a greater increase in the EEN group (P < 0.05). Inflammatory markers significantly decreased in both groups, with the EEN group experiencing a greater reduction (P < 0.05). Additionally, the overall incidence of adverse reactions in both groups was low and improved with treatment adjustments. CONCLUSION EN significantly improved clinical conditions and nutritional status and reduced inflammation levels and disease activity in adult patients with moderate to severe CD undergoing UST-induced remission. EEN was found to be superior to PEN in these aspects.
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Affiliation(s)
- S Liao
- Department of Gastroenterology and Hepatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - B Wang
- Department of Gastroenterology and Hepatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Z Zheng
- Department of Gastroenterology and Hepatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - S Ye
- Department of Gastroenterology and Hepatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - L Huang
- Department of Gastroenterology and Hepatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Y Zheng
- Department of Nutrition, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
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Vuijk SA, Camman AE, de Ridder L. Considerations in Paediatric and Adolescent Inflammatory Bowel Disease. J Crohns Colitis 2024; 18:ii31-ii45. [PMID: 39475081 PMCID: PMC11523044 DOI: 10.1093/ecco-jcc/jjae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/03/2024] [Accepted: 06/11/2024] [Indexed: 11/02/2024]
Abstract
The incidence of inflammatory bowel disease [IBD] is rising most rapidly among children and adolescents. Paediatric-onset IBD is associated with a more extensive and severe disease course compared to adult-onset IBD. At a young age, screening for underlying genetic and immunological disorders is important and may impact treatment management. Early and effective treatment is crucial to reach disease remission and prevent complications of ongoing active disease. In children with Crohn's disease, exclusive enteral nutrition is an effective induction therapy. Other promising dietary therapies, such as the Crohn's disease exclusion diet, are emerging. Within paediatric IBD, anti-tumour necrosis factor therapy is the only approved biological thus far and additional treatment options are crucially needed. Other biological therapies, such as vedolizumab and ustekinumab, are currently prescribed off-label in this population. A specific challenge in paediatric IBD is the unacceptable and major delay in approval of drugs for children with IBD. A guided transfer period of paediatric patients to adult care is associated with improved disease outcomes and is required. Major knowledge gaps and challenges within paediatric IBD include the aetiology, diagnostics, and monitoring of disease, tailoring of treatment, and both understanding and coping with the physical and psychological consequences of living with IBD. Challenges and research gaps in paediatrics should be addressed without any delay in comparison with the adult field, in order to ensure a high quality of care for all patients with IBD, irrespective of the age of onset.
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Affiliation(s)
- Stephanie A Vuijk
- Department of Paediatric Gastroenterology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Anouk E Camman
- Department of Paediatric Gastroenterology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Lissy de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
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Geesala R, Gongloor P, Recharla N, Shi XZ. Mechanisms of Action of Exclusive Enteral Nutrition and Other Nutritional Therapies in Crohn's Disease. Nutrients 2024; 16:3581. [PMID: 39519414 PMCID: PMC11547457 DOI: 10.3390/nu16213581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/18/2024] [Accepted: 10/19/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Crohn's disease (CD) is an inflammatory bowel disease (IBD) characterized by transmural inflammation and intestinal fibrosis involving mostly the small intestine and colon. The pathogenic mechanisms of CD remain incompletely understood and cures are unavailable. Current medical therapies are aimed at inducing prolonged remission. Most of the medical therapies such as corticosteroids have substantial adverse effects. Consequently, many dietary therapies have been explored for the management of CD. Up to now, exclusive enteral nutrition (EEN) has been considered the only established dietary treatment for IBD, especially CD. In this article, we aim to give a concise review about the current therapeutic options and challenges in the management of CD and aim to compare the efficacy of EEN with other dietary therapies and update on the possible mechanisms of the benefits of EEN and other nutritional therapies. METHODS We searched the literature up to August 2024 through PubMed, Web of Science, and other sources using search terms such as EEN, nutritional therapy, IBD, Crohn's disease, ulcerative colitis. Clinical studies in patients and preclinical studies in rodent models of IBD were included in the summary of the therapeutic benefits. RESULTS AND CONCLUSIONS EEN involves oral or nasogastric tube feeding of a complete liquid diet with exclusion of normal foods for a defined period (usually 6 to 8 weeks). EEN treatment is demonstrated to have anti-inflammatory and healing effects in CD through various potential pathways, including altering gut bacteria and their metabolites, restoring the barrier function, direct anti-inflammatory action, and indirect anti-inflammatory action by eliminating mechanical stress in the bowel. However, efficacy of other nutritional therapies is not well established in CD, and mechanisms of action are largely unknown.
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Affiliation(s)
- Ramasatyaveni Geesala
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA; (R.G.); (N.R.)
| | - Pratik Gongloor
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Neeraja Recharla
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA; (R.G.); (N.R.)
| | - Xuan-Zheng Shi
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX 77555, USA; (R.G.); (N.R.)
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Migdanis A, Migdanis I, Gkogkou ND, Papadopoulou SK, Giaginis C, Manouras A, Polyzou Konsta MA, Kosti RI, Oikonomou KA, Argyriou K, Potamianos S, Kapsoritakis A. The Relationship of Adherence to the Mediterranean Diet with Disease Activity and Quality of Life in Crohn's Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1106. [PMID: 39064535 PMCID: PMC11279084 DOI: 10.3390/medicina60071106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Emerging evidence is placing the Mediterranean diet (MD) in the spotlight as a potential dietary model that could benefit inflammatory bowel disease (IBD) patients in terms of prevention and progress of the disease. The main aim of the present study is to shed some light on the relationship between the adherence to the MD and the degree of disease activity, as well as the quality of life in patients with Crohn's disease (CD). Materials and Methods: An administered questionnaire was used to assess and record a number of parameters, including recent medical and weight history, anthropometric characteristics, disease activity (in remission or active disease), and quality of life of both male and female CD patients. Moreover, the level of compliance of the participants to the Mediterranean diet model was evaluated and its relationship with disease activity and quality of life was investigated. Results: Adherence to the MD was significantly higher in patients with inactive disease than in those with active disease (p = 0.019). According to the correlation analysis conducted, adherence to the MD was negatively correlated with disease activity (p = 0.039) and positively correlated with quality of life (QoL) (p = 0.046) of the participants. Intake of fruits, vegetables, and dairy products was significantly higher in remission patients (p = 0.046, p = 0.001, p = 0.041, respectively). Conclusions: We conclude, according to the findings of the study, that adherence to the MD is associated with disease activity and QoL in patients with CD. Future research should focus on MD intervention studies on IBD patients in order to assess its effect on modulating disease activity/course and related inflammatory biomarkers.
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Affiliation(s)
- Athanasios Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
| | - Ioannis Migdanis
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
| | - Nikoleta D. Gkogkou
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Nea Moudania, 57001 Thessaloniki, Greece;
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, University of the Aegean, Myrina, 81400 Lemnos, Greece;
| | - Athanasios Manouras
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
| | | | - Rena I. Kosti
- Nutrition and Dietetics Department, University of Thessaly, Argonafton 1C, 42132 Trikala, Greece; (I.M.); (A.M.); (R.I.K.)
| | - Konstantinos A. Oikonomou
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Konstantinos Argyriou
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Spyridon Potamianos
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
| | - Andreas Kapsoritakis
- Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece; (S.P.); (A.K.)
- MSc Program Nutrition in Health and Disease, Faculty of Medicine, University of Thessaly, Viopolis Mezourlo, 41110 Larissa, Greece;
- Department of Gastroenterology, University Hospital of Larissa, Viopolis Mezourlo, 41110 Larissa, Greece; (K.A.O.); (K.A.)
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Lee D, Braly K, Nuding M, Braly I, Hopp C, Twible H, Pope C, Hayden HS, Hoffman L, Zheng H, Wahbeh G, Suskind DL. Reverse-engineered exclusive enteral nutrition in pediatric Crohn's disease: A pilot trial. J Pediatr Gastroenterol Nutr 2024; 78:1135-1142. [PMID: 38558411 DOI: 10.1002/jpn3.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/18/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In pediatric Crohn's disease (CD), commercial formulas used as exclusive enteral nutrition (EEN) are effective at inducing remission. This study aims to assess the impact of a whole-food blended smoothie as EEN on CD activity and the intestinal microbiome. METHODS A 4-week prospective trial assessed the impact of EEN with a whole-food smoothie on newly diagnosed mild-to-moderate active pediatric CD. The smoothie with a multivitamin were developed to meet age-appropriate nutritional requirements. Assessment over 4 weeks included Pediatric Crohn's Disease Activity Index (PCDAI), serum laboratories, fecal calprotectin (FCP), and stool collection for metagenomic shotgun sequencing and microbiota composition analysis. Clinical remission was defined as PCDAI ≤ 10 at week 4. RESULTS Ten participants were enrolled with median age 14.5 years, and 8 completed the trial. Baseline mean PCDAI was 26.3 ± 9.1 and mean FCP 1149 ± 718 µg/g. At week 4, 80% of participants achieved clinical remission. FCP decreased by over half in 60% of participants, with FCP below 250 µg/g in 60% and below 100 µg/g in 40%. Microbiome analysis showed a significant increase in species richness over 4 weeks (p = 0.01). Compared to baseline, the relative abundance at week 2 and at week 4 was significantly increased for Bifidobacterium and Streptococcus and decreased for Blautia (p < 0.05 for all). CONCLUSION A whole-food blended smoothie was effective for inducing clinical remission and decreasing FCP in pediatric CD similar to commercial EEN formulas. Further research may give insight into data-driven whole-food dietary approaches for CD management. CLINICALTRIALS gov NCT03508193.
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Affiliation(s)
- Dale Lee
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kim Braly
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mason Nuding
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ian Braly
- Department of Chemical Engineering, University of Washington, Seattle, Washington, USA
| | - Courtney Hopp
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Heather Twible
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Christopher Pope
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Hillary S Hayden
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Luke Hoffman
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Microbiology, University of Washington, Seattle, Washington
| | - Hengqi Zheng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ghassan Wahbeh
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - David L Suskind
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Inflammatory Bowel Disease Center, Seattle Children's Hospital, Seattle, Washington, USA
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Geesala R, Zhang K, Lin YM, Johnson JC, Cong Y, Cohn S, Shi XZ. Exclusive Enteral Nutrition Alleviates Th17-Mediated Inflammation via Eliminating Mechanical Stress-Induced Th17-Polarizing Cytokines in Crohn's-like Colitis. Inflamm Bowel Dis 2024; 30:429-440. [PMID: 37536273 PMCID: PMC10906353 DOI: 10.1093/ibd/izad158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS Exclusive enteral nutrition (EEN) with a liquid diet is the only established dietary treatment for Crohn's' disease (CD). However, the mechanism of action of EEN in CD is unclear. T helper 17 (Th17) immune response plays a critical role in CD. We hypothesized that EEN alleviates Th17 response by eliminating mechanical stress-induced expression of Th17-polarizing cytokines. METHODS A rat model of Crohn's-like colitis was established by intracolonic instillation of TNBS (65 mg/kg in 250 µL of 40% ethanol). Control rats were treated with saline. We characterized immunophenotypes and molecular changes of the colon in control and colitis rats with and without EEN treatment. Th17 differentiation was determined using coculture assays. RESULTS TNBS instillation induced transmural inflammation with stenosis in the inflammation site and a marked increase of Th17-polarizing cytokines interleukin (IL)-6 and osteopontin and the Th17 cell population in the mechanically distended preinflammation site (P-site). EEN treatment eliminated mechanical distention and the increase of IL-6, osteopontin, and Th17 response in the P-site. IL-6 and osteopontin expression was found mainly in the muscularis externa. Mechanical stretch of colonic smooth muscle cells in vitro induced a robust increase of IL-6 and osteopontin. When naïve T cells were cultured with conditioned media from the P-site tissue or stretched cells, Th17 differentiation was significantly increased. Inhibition of IL-6, but not deletion of osteopontin, blocked the increase of Th17 differentiation. CONCLUSIONS Mechanical stress induces Th17-polarizing cytokines in the colon. EEN attenuates Th17 immune response by eliminating mechanical stress-induced IL-6 in Crohn's-like colitis.
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Affiliation(s)
- Ramasatyaveni Geesala
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Ke Zhang
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - You-Min Lin
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - John C Johnson
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Yingzi Cong
- Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Steven Cohn
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Xuan-Zheng Shi
- Department of Internal Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA
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11
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Borinsky SA, Cameron BA, Xue Z, LaFata S, Kiran A, Ocampo AA, McCallen J, Lee CJ, Redd WD, Cotton CC, Eluri S, Reed CC, Dellon ES. Feeding Tube Placement, Complications, and Treatment Responses in a Large Eosinophilic Esophagitis Patient Population. J Pediatr Gastroenterol Nutr 2023; 77:753-759. [PMID: 37697476 PMCID: PMC11213236 DOI: 10.1097/mpg.0000000000003941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Feeding tubes can provide a temporary or long-term solution for nutritional therapy. Little is known regarding the use of feeding tubes in patients with eosinophilic esophagitis (EoE). We sought to describe the characteristics and outcomes in EoE patients requiring tube feeding. METHODS This was a retrospective cohort study of EoE patients at a large tertiary care health system. Demographics, clinical characteristics, and endoscopic findings were extracted from medical records, and patients who had a feeding tube were identified. Patients with and without a feeding tube were compared. Details about the tube, complications, and treatment were extracted. Growth, global symptomatic, endoscopic, and histopathologic (<15 eos/hpf) responses were compared before and after the initiation of feeding tube therapy. RESULTS We identified 39 of 1216 EoE patients who had a feeding tube (3%). Feeding tube patients were younger (mean age 6.3 years), reported more vomiting, and had a lower total endoscopic reference score than non-feeding tube patients ( P < 0.01 for all). Tubes were used for therapy for an average of 6.8 years, with most patients (95%) receiving both pharmacologic and formula treatment for EoE. An emergency department visit for a tube complication was required in 26%. Tube feeding improved body mass index z score ( P < 0.01), symptomatic response (42%), endoscopic response (53%), and histologic response (71%). CONCLUSIONS Among EoE patients, only a small subset required a feeding tube and predominantly were young children with failure to thrive. Feeding tubes significantly improved growth and, when used in combination with other treatments, led to reduced esophageal eosinophilic inflammation.
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Affiliation(s)
- Stephanie A Borinsky
- From the Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Brenderia A Cameron
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Zeyun Xue
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Sean LaFata
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Akshatha Kiran
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Adolfo A Ocampo
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Justin McCallen
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Christopher J Lee
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Walker D Redd
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Cary C Cotton
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Swathi Eluri
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Craig C Reed
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan S Dellon
- the Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- the Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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12
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Urlep D, Orel R, Kunstek P, Benedik E. Treatment of Active Crohn's Disease in Children Using Partial Enteral Nutrition Combined with a Modified Crohn's Disease Exclusion Diet: A Pilot Prospective Cohort Trial on Clinical and Endoscopic Outcomes. Nutrients 2023; 15:4676. [PMID: 37960328 PMCID: PMC10650058 DOI: 10.3390/nu15214676] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Partial enteral nutrition (PEN) coupled with the Crohn's disease (CD) exclusion diet (CDED) was shown to be effective in inducing clinical remission in paediatric CD. There are currently no robust data on the endoscopic outcomes of PEN. The aim of this study was to evaluate the clinical and endoscopic rates of remission after PEN combined with a modified CDED (mCDED) adjusted to the local cuisine in comparison with exclusive enteral nutrition (EEN) for the induction of remission. METHODS Between June 2017 and February 2021, a prospective cohort study on children with active CD, treated with PEN + mCDED or EEN, was performed at a single tertiary centre. RESULTS During the study period, 54 patients were screened and 15 were excluded according to the exclusion criteria, with six patients excluded in the first two days due to intolerance of the enteral formula. Fourteen patients were included in the PEN and 19 in the EEN group. They were assessed at Weeks 0, 1, 3 and 6, using clinical and laboratory parameters. Endoscopy was performed at Weeks 0 and 6. Clinical remission rates per protocol analysis were 84.6% in the PEN group and 81.3% in the EEN group (p = 0.99). At Week 6, an endoscopic response (a decline in the Simple Endoscopic Score for CD (SES-CD) > 50%) was observed in 84.6% of patients on PEN and in 68.8% on EEN treatment (p = 0.41). Endoscopic remission (SES-CD ≤ 2) was achieved in 53.8% of patients in the PEN group and in 50.0% in the EEN group (p = 0.99), while the mucosal healing rates (SES-CD = 0) were 38.5% with PEN and 43.8% with EEN (p = 0.99). A significant decline in the clinical and endoscopic activity scores was observed in both groups. CONCLUSION Our study suggests that PEN + mCDED could be effective in inducing endoscopic remission and mucosal healing in active paediatric CD patients. Here, we present an analysis of the data from our cohort of patients and our real-world experience with PEN + mCDED.
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Affiliation(s)
- Darja Urlep
- Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, 1000 Ljubljana, Slovenia; (D.U.); (R.O.); (P.K.)
| | - Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, 1000 Ljubljana, Slovenia; (D.U.); (R.O.); (P.K.)
| | - Patricija Kunstek
- Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, 1000 Ljubljana, Slovenia; (D.U.); (R.O.); (P.K.)
| | - Evgen Benedik
- Department of Gastroenterology, Hepatology and Nutrition, University Children’s Hospital Ljubljana, 1000 Ljubljana, Slovenia; (D.U.); (R.O.); (P.K.)
- Biotechnical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
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13
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O’Reilly C, Mills S, Rea MC, Lavelle A, Ghosh S, Hill C, Ross RP. Interplay between inflammatory bowel disease therapeutics and the gut microbiome reveals opportunities for novel treatment approaches. MICROBIOME RESEARCH REPORTS 2023; 2:35. [PMID: 37849974 PMCID: PMC7615213 DOI: 10.20517/mrr.2023.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/19/2023]
Abstract
Inflammatory bowel disease (IBD) is a complex heterogeneous disorder defined by recurring chronic inflammation of the gastrointestinal tract, attributed to a combination of factors including genetic susceptibility, altered immune response, a shift in microbial composition/microbial insults (infection/exposure), and environmental influences. Therapeutics generally used to treat IBD mainly focus on the immune response and include non-specific anti-inflammatory and immunosuppressive therapeutics and targeted therapeutics aimed at specific components of the immune system. Other therapies include exclusive enteral nutrition and emerging stem cell therapies. However, in recent years, scientists have begun to examine the interplay between these therapeutics and the gut microbiome, and we present this information here. Many of these therapeutics are associated with alterations to gut microbiome composition and functionality, often driving it toward a "healthier profile" and preclinical studies have revealed that such alterations can play an important role in therapeutic efficacy. The gut microbiome can also improve or hinder IBD therapeutic efficacy or generate undesirable metabolites. For certain IBD therapeutics, the microbiome composition, particularly before treatment, may serve as a biomarker of therapeutic efficacy. Utilising this information and manipulating the interactions between the gut microbiome and IBD therapeutics may enhance treatment outcomes in the future and bring about new opportunities for personalised, precision medicine.
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Affiliation(s)
- Catherine O’Reilly
- Food Biosciences Department, Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork P61C996, Ireland
- Microbiology Department, University College Cork, Co. Cork T12TP07, Ireland
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
- Authors contributed equally
| | - Susan Mills
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
- Authors contributed equally
| | - Mary C. Rea
- Food Biosciences Department, Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork P61C996, Ireland
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
| | - Aonghus Lavelle
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
| | - Subrata Ghosh
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
| | - Colin Hill
- Microbiology Department, University College Cork, Co. Cork T12TP07, Ireland
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
| | - R. Paul Ross
- Microbiology Department, University College Cork, Co. Cork T12TP07, Ireland
- APC Microbiome Ireland, University College Cork, Co. Cork T12YT20, Ireland
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14
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Murthy SK, Weizman AV, Kuenzig ME, Windsor JW, Kaplan GG, Benchimol EI, Bernstein CN, Bitton A, Coward S, Jones JL, Lee K, Peña-Sánchez JN, Rohatinsky N, Ghandeharian S, Sabrie N, Gupta S, Brar G, Khan R, Im JHB, Davis T, Weinstein J, St-Pierre J, Chis R, Meka S, Cheah E, Goddard Q, Gorospe J, Kerr J, Beaudion KD, Patel A, Russo S, Blyth J, Blyth S, Charron-Bishop D, Targownik LE. The 2023 Impact of Inflammatory Bowel Disease in Canada: Treatment Landscape. J Can Assoc Gastroenterol 2023; 6:S97-S110. [PMID: 37674501 PMCID: PMC10478812 DOI: 10.1093/jcag/gwad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
The therapeutic landscape for inflammatory bowel disease (IBD) has changed considerably over the past two decades, owing to the development and widespread penetration of targeted therapies, including biologics and small molecules. While some conventional treatments continue to have an important role in the management of IBD, treatment of IBD is increasingly moving towards targeted therapies given their greater efficacy and safety in comparison to conventional agents. Early introduction of these therapies-particularly in persons with Crohn's disease-combining targeted therapies with traditional anti-metabolite immunomodulators and targeting objective markers of disease activity (in addition to symptoms), have been shown to improve health outcomes and will be increasingly adopted over time. The substantially increased costs associated with targeted therapies has led to a ballooning of healthcare expenditure to treat IBD over the past 15 years. The introduction of less expensive biosimilar anti-tumour necrosis factor therapies may bend this cost curve downwards, potentially allowing for more widespread access to these medications. Newer therapies targeting different inflammatory pathways and complementary and alternative therapies (including novel diets) will continue to shape the IBD treatment landscape. More precise use of a growing number of targeted therapies in the right individuals at the right time will help minimize the development of expensive and disabling complications, which has the potential to further reduce costs and improve outcomes.
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Affiliation(s)
- Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Adam V Weizman
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph W Windsor
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gilaad G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Nasruddin Sabrie
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarang Gupta
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gurmun Brar
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rabia Khan
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joëlle St-Pierre
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roxana Chis
- Department of Gastroenterology and Hepatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Saketh Meka
- Department of Neuroscience, McGill University, Montreal, Quebec, Canada
| | - Eric Cheah
- Department of Gastroenterology and Clinical Nutrition, The Royal Children’s Hospital Melbourne, Parkville, Australia
| | - Quinn Goddard
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jack Kerr
- Department of Medicine, Memorial University of Newfoundland, St John’s Newfoundland, Canada
| | - Kayla D Beaudion
- Department of Interdisciplinary Science, McMaster University, Hamilton, Ontario, Canada
| | - Ashley Patel
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sophia Russo
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Colombia, Canada
| | | | | | | | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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15
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Cuomo M, Carobbio A, Aloi M, Alvisi P, Banzato C, Bosa L, Bramuzzo M, Campanozzi A, Catassi G, D'Antiga L, Di Paola M, Felici E, Fioretti MT, Gatti S, Graziano F, Lega S, Lionetti P, Marseglia A, Martinelli M, Musto F, Sansotta N, Scarallo L, Zuin G, Norsa L. Induction of Remission With Exclusive Enteral Nutrition in Children With Crohn's Disease: Determinants of Higher Adherence and Response. Inflamm Bowel Dis 2023; 29:1380-1389. [PMID: 36222487 DOI: 10.1093/ibd/izac215] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is the first choice to induce remission and promote mucosal healing in pediatric Crohn's disease (CD). However, full adherence to EEN treatment may be problematic for children with CD. METHODS The goal of the current multicenter retrospective study was to define predictive factors of nonadherence to treatment and nonremission at the end of induction treatment. Those data together were analyzed with the ultimate goal of trying to define an individualized induction treatment for children with CD. RESULTS Three hundred seventy-six children with CD from 14 IBD pediatric referral centers were enrolled in the study. The rate of EEN adherence was 89%. Colonic involvement and fecal calprotectin >600 μg/g at diagnosis were found to be associated with a reduced EEN adherence. Exclusive enteral nutrition administered for 8 weeks was effective for inducing clinical remission in 67% of the total cohort. Factors determining lower remission rates were age >15 years and Pediatric Crohn's Disease Activity Index >50. CONCLUSION Although EEN is extremely effective in promoting disease remission, several patients' related factors may adversely impact EEN adherence and response. Personalized treatments should be proposed that weigh benefits and risks based on the patient's disease location, phenotype, and disease activity and aim to promote a rapid control of inflammation to reduce long-term bowel damage.
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Affiliation(s)
- Marialaura Cuomo
- Department of Pediatrics, San Carlo Hospital - ASST Santi Paolo e Carlo, Milano, Italy
| | | | - Marina Aloi
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | - Claudia Banzato
- Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Luca Bosa
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Matteo Bramuzzo
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giulia Catassi
- Pediatric Gastroenterology and Liver Unit, Department of Maternal and Child Health, Sapienza University of Rome, Roma, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Di Paola
- Gastroenterology and Nutrition Unit, Meyer children's Hospital, Department Neurofarba, University of Florence, Florence, Italy
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, "U. Bosio" Center for Pediatric Digestive Diseases, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Maria Teresa Fioretti
- Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Napoli, Italy
| | - Simona Gatti
- Department of Pediatrics, Polytechnic University of Marche, G. Salesi Children's Hospital, Ancona, Italy
| | | | - Sara Lega
- Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Trieste, Italy
| | - Paolo Lionetti
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Antonio Marseglia
- Division of Pediatrics, "IRCCS Casa Sollievo della Sofferenza", San GiovanniRotondo, Italy
| | - Massimo Martinelli
- Gastroenterology and Nutrition Unit, Meyer children's Hospital, Department Neurofarba, University of Florence, Florence, Italy
| | - Francesca Musto
- Pediatric Department, University of Milano Bicocca, Fondazione MBBM, Onlus San Gerardo Hospital, Monza, Italy
| | - Naire Sansotta
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luca Scarallo
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Giovanna Zuin
- Pediatric Department, University of Milano Bicocca, Fondazione MBBM, Onlus San Gerardo Hospital, Monza, Italy
| | - Lorenzo Norsa
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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16
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Cohen Y, Valdés-Mas R, Elinav E. The Role of Artificial Intelligence in Deciphering Diet-Disease Relationships: Case Studies. Annu Rev Nutr 2023; 43:225-250. [PMID: 37207358 DOI: 10.1146/annurev-nutr-061121-090535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Modernization of society from a rural, hunter-gatherer setting into an urban and industrial habitat, with the associated dietary changes, has led to an increased prevalence of cardiometabolic and additional noncommunicable diseases, such as cancer, inflammatory bowel disease, and neurodegenerative and autoimmune disorders. However, while dietary sciences have been rapidly evolving to meet these challenges, validation and translation of experimental results into clinical practice remain limited for multiple reasons, including inherent ethnic, gender, and cultural interindividual variability, among other methodological, dietary reporting-related, and analytical issues. Recently, large clinical cohorts with artificial intelligence analytics have introduced new precision and personalized nutrition concepts that enable one to successfully bridge these gaps in a real-life setting. In this review, we highlight selected examples of case studies at the intersection between diet-disease research and artificial intelligence. We discuss their potential and challenges and offer an outlook toward the transformation of dietary sciences into individualized clinical translation.
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Affiliation(s)
- Yotam Cohen
- Systems Immunology Department, Weizmann Institute of Science, Rehovot, Israel;
| | - Rafael Valdés-Mas
- Systems Immunology Department, Weizmann Institute of Science, Rehovot, Israel;
| | - Eran Elinav
- Systems Immunology Department, Weizmann Institute of Science, Rehovot, Israel;
- Division of Microbiome & Cancer, National German Cancer Research Center (DKFZ), Heidelberg, Germany;
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17
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Minhas HJ, Papamichael K, Cheifetz AS, Gianotti RJ. A primer on common supplements and dietary measures used by patients with inflammatory bowel disease. Ther Adv Chronic Dis 2023; 14:20406223231182367. [PMID: 37426698 PMCID: PMC10328183 DOI: 10.1177/20406223231182367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic disease of the intestines. The pathophysiology of IBD, namely Crohn's disease and ulcerative colitis, is a complex interplay between environmental, genetic, and immune factors. Physicians and patients often seek complementary and alternative medicines (CAMs) as primary and supplementary treatment modalities. CAMs in IBD span a wide range of plants, herbs, pre/probiotics, and include formulations, such as cannabis, curcumin, fish oil, and De Simone Formulation. Dietary measures are also used to improve symptoms by attempting to target trigger foods and reducing inflammation. Examples include the specific carbohydrate diet, the Mediterranean diet, and a diet low in fermentable oligo-, di- and monosaccharides as well as polyols (FODMAP). We examine and review the most common complementary supplements and diets used by patients with IBD.
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Affiliation(s)
- Hadi J Minhas
- Department of Gastroenterology, Albany Medical Center, Albany NY, USA
| | - Konstantinos Papamichael
- Division of Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Adam S. Cheifetz
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Robert J. Gianotti
- Department of Gastroenterology, Albany Medical Center, Albany NY, USA
- Albany Gastroenterology Consultants, Albany, NY, USA
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18
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Levine AE, Mark D, Smith L, Zheng HB, Suskind DL. Pharmacologic Management of Monogenic and Very Early Onset Inflammatory Bowel Diseases. Pharmaceutics 2023; 15:969. [PMID: 36986830 PMCID: PMC10059893 DOI: 10.3390/pharmaceutics15030969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Inflammatory bowel disease (IBD) is treated with a variety of immunomodulating and immunosuppressive therapies; however, for the majority of cases, these therapies are not targeted for specific disease phenotypes. Monogenic IBD with causative genetic defect is the exception and represents a disease cohort where precision therapeutics can be applied. With the advent of rapid genetic sequencing platforms, these monogenic immunodeficiencies that cause inflammatory bowel disease are increasingly being identified. This subpopulation of IBD called very early onset inflammatory bowel disease (VEO-IBD) is defined by an age of onset of less than six years of age. Twenty percent of VEO-IBDs have an identifiable monogenic defect. The culprit genes are often involved in pro-inflammatory immune pathways, which represent potential avenues for targeted pharmacologic treatments. This review will provide an overview of the current state of disease-specific targeted therapies, as well as empiric treatment for undifferentiated causes of VEO-IBD.
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Affiliation(s)
- Anne E. Levine
- Division of Gastroenterology, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Dominique Mark
- Department of Pharmacy, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Laila Smith
- Division of Gastroenterology, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | - Hengqi B. Zheng
- Division of Gastroenterology, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - David L. Suskind
- Division of Gastroenterology, Seattle Children’s Hospital, Seattle, WA 98105, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA 98195, USA
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19
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Alzahrani A, Alzahrani AJ, Shori AB. Inflammatory Bowel Disease: A focus on the Role of Probiotics in Ulcerative Colitis. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a cluster of disorders of the gastrointestinal tract characterized by chronic inflammation and imbalance of the gut microbiota in a genetically vulnerable host. Crohn’s disease and ulcerative colitis (UC) are well-known types of IBD, and due to its high prevalence, IBD has attracted the attention of researchers globally. The exact etiology of IBD is still unknown; however, various theories have been proposed to provide some explanatory clues that include gene-environment interactions and dysregulated immune response to the intestinal microbiota. These diseases are manifested by several clinical symptoms that depend on the affected segment of the intestine such as diarrhea, abdominal pain, and rectal bleeding. In this era of personalized medicine, various options are developing starting from improved intestinal microecology, small molecules, exosome therapy, to lastly stem cell transplantation. From another aspect, and in parallel to pharmacological intervention, nutrition, and dietary support have shown effectiveness in IBD management. There is an increasing evidence supporting the benefit of probiotics in the prophylaxis and treatment of IBD. There are several studies that have demonstrated that different probiotics alleviate UC. The present review summarizes the progress in the IBD studies focusing and exploring more on the role of probiotics as a potential adjunct approach in UC management.
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20
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Oh TY, Hofmekler T, Freeman AJ. Update in Pediatric Gastroenterology and Nutrition. UPDATE IN PEDIATRICS 2023:369-398. [DOI: 10.1007/978-3-031-41542-5_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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21
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Otley A, Day AS, Zachos M. Nutritional Management of Inflammatory Bowel Disease. PEDIATRIC INFLAMMATORY BOWEL DISEASE 2023:355-383. [DOI: 10.1007/978-3-031-14744-9_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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22
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Stoner N, Stein R. Dietary Therapies for Inflammatory Bowel Disease. PEDIATRIC INFLAMMATORY BOWEL DISEASE 2023:521-537. [DOI: 10.1007/978-3-031-14744-9_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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23
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Luo J, Xie YM, Wu M, Zhao JG, Hu LL. Global attitudes on and the status of enteral nutrition therapy for pediatric inflammatory bowel disease. Front Med (Lausanne) 2022; 9:1036793. [PMID: 36569124 PMCID: PMC9773139 DOI: 10.3389/fmed.2022.1036793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022] Open
Abstract
Enteral nutrition (EN) is a diet-remission therapy for inflammatory bowel disease (IBD) that plays a more important role in children than adults. EN includes exclusive enteral nutrition (EEN), partial enteral nutrition (PEN), and maintenance enteral nutrition (MEN). However, EEN remains an unstandardized treatment for pediatric IBD. The types and methods of EN differ around the world. The current study reviewed the EN literature on children with IBD. A total of 12 survey studies were identified that analyzed the current state of EN use, including clinical opinions, implementation methods, treatment course, EEN formula, IBD classification, progress, dietary reintroduction, and patient feedback. The findings revealed that EEN has a strong effect on mild to moderate Crohn's disease (CD). The usage rates of this treatment in different sites were ileum/colon (Paris classification L3) > ileum (L1) > upper digestive tract (L4) > colon (L2) > perianal disease (P) > ulcerative colitis (UC) > extraintestinal lesions. The polymeric formula was the most used EN formulation. New EN diets include a CD exclusion diet (CDED), a specific carbohydrate diet (SCD), and a CD treatment-with-eating (CD-TREAT) diet. Children with IBD responded similarly to EEN administered orally or using a feeding tube. Most guidelines recommended 6-8 weeks of EEN treatment to induce remission. Many clinicians preferred to combine drug medications during EEN and recommended that MEN accounts for at least 25-35% of daily caloric intake. EN remains an unstandardized therapy that requires teamwork across disciplines.
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Affiliation(s)
- Juan Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Yong-Mei Xie
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China,*Correspondence: Yong-Mei Xie,
| | - Mei Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Jin-Gui Zhao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Liang-Liang Hu
- Department of Pediatrics, Luzhou People’s Hospital, Luzhou, Sichuan, China
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24
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Dawson R, Wands DIF, Logan M, Bremner G, Efklides S, Benn L, Henderson P, Grant H, Meredith J, Armstrong K, Wilson DC, Gerasimidis K, Alex G, Russell RK. Comparing Effectiveness of a Generic Oral Nutritional Supplement With Specialized Formula in the Treatment of Active Pediatric Crohn's Disease. Inflamm Bowel Dis 2022; 28:1859-1864. [PMID: 35259266 DOI: 10.1093/ibd/izac039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is the recommended induction treatment of mild to moderate active pediatric Crohn's disease (CD). This study compared outcomes of 2 proprietary polymeric formulas. Treatment effectiveness was examined along with practical aspects of formula delivery and differences in estimated treatment costs. METHODS Data were retrospectively collected from patients with CD who received a generic oral nutritional supplement (Fortisip) across 2 centers (RCH, Melbourne and RHSC, Edinburgh). This was compared with a prospective cohort (RHC, Glasgow) that used a specialized formula (Modulen IBD). The data collected included patient demographics, remission rates, biochemical markers, administration method, and anthropometrics. The estimated treatment cost was performed by comparing price per kcal between each formula. RESULTS One hundred seventy-one patients were included (106 Fortisip, 65 Modulen IBD, 70 female; median age 13.3 yrs). No difference was demonstrated in remission rate (Fortisip n = 67 of 106 [63%] vs Modulen IBD n = 41 of 64 [64%], P = .89), nonadherence rate (Fortisip n = 7 of 106 [7%] vs Modulen IBD 3 of 64 [5%], P = .57) or method of administration (NGT Fortisip use n = 16 of 106 [12%] vs Modulen IBD 14 of 65 [22%]; P = .31). There was no difference in reduction of biochemical disease markers between the groups (C-reactive protein , P = .13; erythrocyte sedimentation rate, P = .49; fecal calprotectin, P = .94). However, there was a cost-saving of around £500/patient/course if the generic oral nutritional supplement was used. CONCLUSIONS The generic oral nutritional supplement and specialized formulas both had similar clinical effectiveness in induction of remission in pediatric CD. However, there is considerable cost-saving when using a generic oral nutritional supplement.
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Affiliation(s)
- R Dawson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - D I F Wands
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- Department of Gastroenterology, Hepatology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Logan
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - G Bremner
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - S Efklides
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - L Benn
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - P Henderson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young people, Edinburgh, UK
| | - H Grant
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - J Meredith
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - K Armstrong
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - D C Wilson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young people, Edinburgh, UK
| | - K Gerasimidis
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - G Alex
- Department of Gastroenterology, Hepatology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - R K Russell
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
- Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young people, Edinburgh, UK
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25
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Limketkai BN, Hamideh M, Shah R, Sauk JS, Jaffe N. Dietary Patterns and Their Association With Symptoms Activity in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2022; 28:1627-1636. [PMID: 35092268 DOI: 10.1093/ibd/izab335] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Existing studies on diet and inflammatory bowel disease (IBD) have largely focused on evaluating the effects of single nutrients or whole predesigned diets but not on evaluating the effects of diverse dietary patterns. This study applied unsupervised methods to identify dietary patterns of individuals with IBD and evaluated their association with symptoms activity. METHODS This retrospective study of adults with IBD collected current clinical data and typical diet recalled from the time when in clinical remission. Discrete dietary structures were defined by k-means clustering. Multivariable logistic regression evaluated the relationship between diet clusters and the presence of active symptoms, while adjusting for age, sex, disease duration, disease behavior, and medication use. RESULTS Of 691 participants, 36% had Crohn's disease (CD) and 64% had ulcerative colitis (UC) or IBD-unclassified. Five major dietary clusters were identified: 2 resembled a Western diet (WD) (WD1, WD2), 1 resembled a balanced diet, and 2 resembled a plant-based diet (PB) (PB1, PB2). Compared with WD1, PB2 was associated with lower odds of active symptoms for CD (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.12-0.83) and UC (OR, 0.31; 95% CI, 0.15-0.62). PB1 was associated with lower odds of active symptoms for participants with UC (OR, 0.45; 95% CI, 0.23-0.90) but not for participants with CD (OR, 0.95; 95% CI, 0.36-2.51). CONCLUSIONS Diets with increased intake of fruits and vegetables, reduction of processed meats and refined carbohydrates, and preference of water for hydration were associated with lower risk of active symptoms with IBD, although increased intake of fruits and vegetables alone did not reduce risk of symptoms with CD.
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Affiliation(s)
- Berkeley N Limketkai
- Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mohamed Hamideh
- Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Rishabh Shah
- Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jenny S Sauk
- Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nancee Jaffe
- Center for Inflammatory Bowel Diseases, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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26
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El Koofy NM, Moawad EMI, Yassin NA, Almohammady MN, Ibrahim GS, El Mougy FA, El Ayadi AA, Tarek S. Basic anthropometry, micronutrients status and growth velocity of patients with early-onset inflammatory bowel disease: A prospective cohort study. Arab J Gastroenterol 2022; 23:270-276. [PMID: 35918289 DOI: 10.1016/j.ajg.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/03/2021] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND STUDY AIM Failure of optimal growth and lack of appropriate weight gain are major nutritional problems in children with inflammatory bowel disease (IBD). Therefore, this study was designed to assess the nutritional and growth status of patients with very-early-onset IBD (VEO-IBD) before and after individual-based nutritional interventions. PATIENTS AND METHODS This prospective cohort study assessed the nutritional status of 30 pediatric patients with VEO-IBD by performing comprehensive clinical examinations and evaluating anthropometric and biochemical parameters. The latter included the initial evaluation of serum albumin, prealbumin, minerals, and 25-hydroxyvitamin D. A 24-month nutritional strategy was designed for each patient. Patients who completed the study were reassessed after 6 months and their growth rate was calculated 2 years later. RESULTS The initial assessment of malnutrition severity using the World Health Organization's z-score revealed that 36.7%, 43.3%, and 26.7% of the study group were underweight, stunted, and wasted, respectively. Among the study population, Crohn's disease has the highest prevalence. Almost all patients had micronutrient deficiencies (i.e., iron, calcium, zinc, magnesium, and vitamin D) and subnormal serum levels of nutritional markers (i.e., prealbumin and albumin). Six months after the intervention, a significant improvement in anthropometric and biochemical parameters was detected (p < 0.05); nevertheless, the calculated growth rate revealed a considerable decrease after 2 years. CONCLUSION The early detection of nutritional impairment in patients with VEO-IBD remains a major challenge. Therefore, nutritional support and constant monitoring of these patients are necessary to ensure the improvement in their nutritional status and achieve an acceptable growth rate. Furthermore, we found that prealbumin could be a good discriminative tool for screening malnutrition in such patients.
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Affiliation(s)
- Nehal M El Koofy
- Pediatric Department, Faculty of Medicine Cairo University, Cairo, Egypt
| | | | - Noha A Yassin
- Pediatric Department, Faculty of Medicine Cairo University, Cairo, Egypt
| | | | - Gehan S Ibrahim
- Pediatric Department, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Fatma A El Mougy
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A El Ayadi
- Pediatric Department, Faculty of Medicine Cairo University, Cairo, Egypt
| | - Sara Tarek
- Pediatric Department, Faculty of Medicine Cairo University, Cairo, Egypt.
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27
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Bechtold ML, Brown PM, Escuro A, Grenda B, Johnston T, Kozeniecki M, Limketkai BN, Nelson KK, Powers J, Ronan A, Schober N, Strang BJ, Swartz C, Turner J, Tweel L, Walker R, Epp L, Malone A. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr 2022; 46:1470-1496. [PMID: 35838308 DOI: 10.1002/jpen.2364] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/07/2022]
Abstract
Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence-based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.
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Affiliation(s)
| | | | | | - Brandee Grenda
- Morrison Healthcare at Atrium Health Navicant, Charlotte, North Carolina, USA
| | - Theresa Johnston
- Nutrition Support Team, Christiana Care Health System, Newark, Delaware, USA
| | | | | | | | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | - Andrea Ronan
- Fanconi Anemia Research Fund, Eugene, Oregon, USA
| | - Nathan Schober
- Cancer Treatment Centers of America - Atlanta, Newnan, Georgia, USA
| | | | - Cristina Swartz
- Northwestern Medicine Delnor Cancer Center, Chicago, Illinois, USA
| | - Justine Turner
- Department of Pediatrics, Division of Gastroenterology and Nutrition, University of Alberta, Edmonton, Canada
| | | | - Renee Walker
- Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, USA
| | - Lisa Epp
- Mayo Clinic, Rochester, Minnesota, USA
| | - Ainsley Malone
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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28
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Levine AE, Zheng HB, Suskind DL. Linking Genetic Diagnosis to Therapeutic Approach in Very Early Onset Inflammatory Bowel Disease: Pharmacologic Considerations. Paediatr Drugs 2022; 24:207-216. [PMID: 35467244 DOI: 10.1007/s40272-022-00503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
Very early onset inflammatory bowel disease (VEO-IBD) is diagnosed in children < 6 years of age, and in rare cases may be due to an identifiable monogenic cause. Recent advances in genetic testing have allowed for more accurate diagnosis, with as many as 100 genes now known to be associated with monogenic inflammatory bowel disease. These genes are involved in many immune pathways and thus may represent potential avenues for targeted precision medicine with pharmacologic treatments aimed at these. This review describes the broad classifications of monogenic disorders known to cause VEO-IBD, as well as empiric and disease-specific medical therapies. These include immune-modulating or immunosuppressant medications, nutritional therapy, surgery, and hematopoietic stem cell transplantation. We aim to provide an overview of the current state of targeted therapy for VEO-IBD.
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Affiliation(s)
- Anne E Levine
- Division of Gastroenterology, Seattle Children's Hospital Inflammatory Bowel Disease Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Hengqi B Zheng
- Division of Gastroenterology, Seattle Children's Hospital Inflammatory Bowel Disease Center, Seattle, WA, USA
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - David L Suskind
- Division of Gastroenterology, Seattle Children's Hospital Inflammatory Bowel Disease Center, Seattle, WA, USA.
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
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29
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Jackman L, Arpe L, O' Connor G. Exclusive enteral nutrition practices in the management of Crohn’s disease: a cross sectional survey of specialist paediatric dietitians. Clin Nutr ESPEN 2022; 49:252-255. [PMID: 35623822 DOI: 10.1016/j.clnesp.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
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30
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Burgess D, McGrath KH, Watson C, Collins T, Brown S, Marks K, Dehlsen K, Herbison K, Landorf E, Benn L, Fox J, Liew M. Exclusive enteral nutrition: An optimal care pathway for use in children with active luminal Crohn's disease. J Paediatr Child Health 2022; 58:572-578. [PMID: 35181966 DOI: 10.1111/jpc.15911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 01/16/2022] [Accepted: 01/24/2022] [Indexed: 12/30/2022]
Abstract
AIM Exclusive enteral nutrition (EEN) is recommended as a first-line therapy for active luminal paediatric Crohn's disease, by many contemporary consensus guidelines. However, EEN protocols vary internationally. A key enabler for the use of EEN therapy has been identified as the standardisation of protocols. The aim of this study was to develop an optimal care pathway for use of EEN in children with active luminal Crohn's disease. METHODS A working group of 11 paediatric gastroenterology dietitians and one paediatric gastroenterologist from Australia and New Zealand was convened to develop a standard optimal care pathway. Seven key areas were identified; clinical indications, workup assessments, EEN prescription, monitoring, food reintroduction, partial enteral nutrition and maintenance enteral nutrition. Recent literature was reviewed, assessed according to the National Health and Medical Research Council guidelines, and consensus statements were developed and voted on. Consensus opinion was used where literature gaps existed. RESULTS A total of nineteen consensus statements from the seven key areas were agreed upon. The consensus statements informed the optimal care pathway for children with active luminal undertaking EEN in Australia and New Zealand. CONCLUSION This study developed an EEN optimal care pathway to facilitate standardisation of clinical care for children with active luminal Crohn's disease, and hopefully improve clinical outcomes and identify areas for future research.
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Affiliation(s)
- Deirdre Burgess
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kathleen H McGrath
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Caitlin Watson
- Department of Paediatric Dietetics, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Tanya Collins
- Department of Paediatric Dietetics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Stephanie Brown
- Department of Paediatrics, Christchurch Public Hospital, Christchurch, New Zealand
| | - Katie Marks
- Children's Hospital Westmead, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Kate Dehlsen
- Sydney Children's Hospital, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Kim Herbison
- Department of Paediatric Dietetics, Starship Children's Hospital, Auckland, New Zealand
| | - Emma Landorf
- Department of Paediatric Dietetics, Womens and Children's Hospital, Adelaide, South Australia, Australia
| | - Laura Benn
- Department of Paediatric Dietetics, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julia Fox
- Department of Paediatric Dietetics, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Ming Liew
- Department of Paediatric Dietetics, Queensland Children's Hospital, Brisbane, Queensland, Australia
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31
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El Amrousy D, Elashry H, Salamah A, Maher S, Abd-Elsalam SM, Hasan S. Adherence to the Mediterranean Diet Improved Clinical Scores and Inflammatory Markers in Children with Active Inflammatory Bowel Disease: A Randomized Trial. J Inflamm Res 2022; 15:2075-2086. [PMID: 35411169 PMCID: PMC8994055 DOI: 10.2147/jir.s349502] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/09/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The Mediterranean diet (MD) is a well-known style of diet that is full of antioxidants and may have anti-inflammatory effects. We evaluated the safety, tolerability, and effects of adherence to MD on disease activity and inflammatory markers in children and adolescents with active inflammatory bowel disease (IBD). METHODS This prospective, randomized study included 100 IBD patients aged twelve to eighteen years with mild to moderate disease activity (PCDAI score 10-45 or PUCAI 10-64). The included patients were divided into two groups of 50 patients each. Group I (26 patients with active CD and 24 patients with active UC) received MD with good adherence over 12 weeks with a KIDMED 8-point score, and group II (28 patients with active CD and 22 patients with active UC) received their usual diet with a KIDMED score ≤7 points. Patients in both groups received treatment similar for IBD activity. RESULTS Clinical remission was achieved in most of the patients after 12 weeks of treatment. Patients in the first group (adhering to an MD) showed a significant decrease in both clinical scores (PCDAI and PUCAI) and most inflammatory markers (CRP, calprotectin, TNF-α, IL17., IL 12 and IL13) compared to patients in their normal group, with earlier improvement in both PCDAI and CRP. CONCLUSION Adherence to the MD improves clinical scores and inflammatory markers in children and adolescents with mild-moderate active IBD.
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Affiliation(s)
- Doaa El Amrousy
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba Elashry
- Tropical Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abeer Salamah
- Pediatric Department, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Sara Maher
- Theodor Bilharz Research Institute, Cairo, Egypt
| | | | - Samir Hasan
- Pediatric Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Fecal Microbiota Transplants for Inflammatory Bowel Disease Treatment: Synthetic- and Engineered Communities-Based Microbiota Transplants Are the Future. Gastroenterol Res Pract 2022; 2022:9999925. [PMID: 35140783 PMCID: PMC8820897 DOI: 10.1155/2022/9999925] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 01/12/2022] [Indexed: 12/21/2022] Open
Abstract
The human intestine harbors a huge number of diverse microorganisms where a variety of complex interactions take place between the microbes as well as the host and gut microbiota. Significant long-term variations in the gut microbiota (dysbiosis) have been associated with a variety of health conditions including inflammatory bowel disease (IBD). Conventional fecal microbiota transplantations (FMTs) have been utilized to treat IBD and have been proved promising. However, various limitations such as transient results, pathogen transfer, storage, and reproducibility render conventional FMT less safe and less sustainable. Defined synthetic microbial communities (SynCom) have been used to dissect the host-microbiota-associated functions using gnotobiotic animals or in vitro cell models. This review focuses on the potential use of SynCom in IBD and its advantages and relative safety over conventional FMT. Additionally, this review reinforces how various technological advances could be combined with SynCom to have a better understanding of the complex microbial interactions in various gut inflammatory diseases including IBD. Some technological advances including the availability of a gut-on-a-chip system, intestinal organoids, ex vivo intestinal cultures, AI-based refining of the microbiome structural and functional data, and multiomic approaches may help in making more practical in vitro models of the human host. Additionally, an increase in the cultured diversity from gut microbiota and the availability of their genomic information would further make the design and utilization of SynCom more feasible. Taken together, the combined use of the available knowledge of the gut microbiota in health and disease and recent technological advances and the development of defined SynCom seem to be a promising, safe, and sustainable alternative to conventional FMT in treating IBD.
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Shi XZ. Mechano-Regulation of Gene Expression in the Gut: Implications in Pathophysiology and Therapeutic Approaches in Obstructive, Inflammatory, and Functional Bowel Disorders. COMPREHENSIVE PHARMACOLOGY 2022:164-185. [DOI: 10.1016/b978-0-12-820472-6.00168-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Sassine S, Zekhnine S, Qaddouri M, Djani L, Cambron-Asselin C, Savoie-Robichaud M, Lin YF, Grzywacz K, Groleau V, Dirks M, Drouin É, Halac U, Marchand V, Girard C, Courbette O, Patey N, Dal Soglio D, Deslandres C, Jantchou P. Factors associated with time to clinical remission in pediatric luminal Crohn's disease: A retrospective cohort study. JGH Open 2021; 5:1373-1381. [PMID: 34950781 PMCID: PMC8674552 DOI: 10.1002/jgh3.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/10/2021] [Indexed: 12/20/2022]
Abstract
Background and Aim Data on factors influencing time to remission in pediatric Crohn's disease (CD) are very limited in the literature. The aim of this retrospective cohort study was to describe the trends of time to clinical remission over the past decade and to identify factors associated with time to clinical remission in children with luminal CD. Methods Patients under 18 years old diagnosed between 2009 and 2019 were included. All data were collected from the patients' medical records. Survival analyses and linear regression models were used to assess the impact of clinical, laboratory, endoscopic, histological, and therapeutic factors on time to clinical remission. Results A total of 654 patients were included in the study. There was no change in the time to clinical remission over the decade. Female sex in adolescents (adjusted bêta regression coefficient [aβ] = 31.8 days, P = 0.02), upper digestive tract involvement (aβ = 46.4 days, P = 0.04) perianal disease (aβ = 32.2 days, P = 0.04), presence of active inflammation on biopsies at diagnosis (aβ = 46.7 days, P = 0.01) and oral 5‐aminosalicylates (5‐ASA) exposure (aβ = 56.6 days, P = 0.002) were associated with longer time to clinical remission. Antibiotic exposure (aβ = −29.3 days, P = 0.04), increased eosinophils (aβ = −29.6 days, P = 0.008) and combination of exclusive enteral nutrition with tumor‐necrosis‐factor‐alpha (TNF‐alpha) inhibitors as induction therapy (aβ = −36.8 days, P = 0.04) were associated with shorter time to clinical remission. Conclusion In children with newly diagnosed Crohn's disease, time to clinical remission did not shorten during the decade. It was associated with baseline clinical and histological data and treatment strategies. Combination of enteral nutrition and TNF‐alpha inhibitors was associated with faster clinical remission.
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Affiliation(s)
- Samuel Sassine
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Souhila Zekhnine
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Marwa Qaddouri
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Lisa Djani
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Christine Cambron-Asselin
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Mathieu Savoie-Robichaud
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Yi Fan Lin
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada
| | - Kelly Grzywacz
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Véronique Groleau
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Martha Dirks
- Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Éric Drouin
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Ugur Halac
- Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Valérie Marchand
- Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Chloé Girard
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Olivier Courbette
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Natalie Patey
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Department of Pathology CHU Sainte-Justine Montreal Quebec Canada
| | - Dorothée Dal Soglio
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Department of Pathology CHU Sainte-Justine Montreal Quebec Canada
| | - Colette Deslandres
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
| | - Prévost Jantchou
- CHU Sainte-Justine Research Center Montreal Quebec Canada.,Faculty of Medicine Université de Montréal Montreal Quebec Canada.,Division of Gastroenterology, Department of Pediatrics CHU Sainte-Justine Montreal Quebec Canada
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Geesala R, Lin YM, Zhang K, Shi XZ. Targeting Mechano-Transcription Process as Therapeutic Intervention in Gastrointestinal Disorders. Front Pharmacol 2021; 12:809350. [PMID: 34992543 PMCID: PMC8724579 DOI: 10.3389/fphar.2021.809350] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022] Open
Abstract
Mechano-transcription is a process whereby mechanical stress alters gene expression. The gastrointestinal (GI) tract is composed of a series of hollow organs, often encountered by transient or persistent mechanical stress. Recent studies have revealed that persistent mechanical stress is present in obstructive, functional, and inflammatory disorders and alters gene transcription in these conditions. Mechano-transcription of inflammatory molecules, pain mediators, pro-fibrotic and growth factors has been shown to play a key role in the development of motility dysfunction, visceral hypersensitivity, inflammation, and fibrosis in the gut. In particular, mechanical stress-induced cyclooxygenase-2 (COX-2) and certain pro-inflammatory mediators in gut smooth muscle cells are responsible for motility dysfunction and inflammatory process. Mechano-transcription of pain mediators such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) may lead to visceral hypersensitivity. Emerging evidence suggests that mechanical stress in the gut also leads to up-regulation of certain proliferative and pro-fibrotic mediators such as connective tissue growth factor (CTGF) and osteopontin (OPN), which may contribute to fibrostenotic Crohn's disease. In this review, we will discuss the pathophysiological significance of mechanical stress-induced expression of pro-inflammatory molecules, pain mediators, pro-fibrotic and growth factors in obstructive, inflammatory, and functional bowel disorders. We will also evaluate potential therapeutic targets of mechano-transcription process for the management of these disorders.
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Keetarut K, Kikuchi H, King B, Richards N, Lomer M, Fragkos K, Patel PS. Perceived acceptability of partial enteral nutrition (PEN) using oral nutritional supplement drinks in adolescent and adult Crohn's disease outpatients: A feasibility study. Clin Nutr ESPEN 2021; 46:276-287. [PMID: 34857209 DOI: 10.1016/j.clnesp.2021.09.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Studies, mainly in Japanese cohorts, have shown that partial enteral nutrition (PEN) including oral nutritional supplement (ONS) drinks can prolong disease remission and increase drug effectiveness in Crohn's disease (CD). Acceptability is a key feasibility parameter to determine whether PEN is a viable treatment option in UK CD patients. We report the results of a single centre cross-sectional feasibility study carried out to investigate perceived acceptability of PEN using ONS drinks and whether ONS preference varies with sex, nutritional status or phenylthiocarbamide (PTC) sensitivity. METHODS Patients with a confirmed CD diagnosis were recruited using convenience sampling from an adult and adolescent gastroenterology outpatient clinic over 3 years. Blind taste testing of 5 polymeric ONS drinks were conducted using a validated 9-point hedonic rating scale followed by completion of an acceptability questionnaire based on the preferred ONS drink. A subset of patients took home the preferred ONS drink for a 7-day ONS study. RESULTS 105 CD patients (55 males), aged 34.9 (±15.4) years were recruited and 28 patients completed the 7-day ONS study. Overall impression scores did not significantly vary with nutritional status, sex, BMI, handgrip strength (HGS), mid-upper arm circumference (MUAC) or PTC sensitivity. Ensure plus milkshake™ rated highest for overall impression (6.5, p=<0.0001) and all other organoleptic properties (p < 0.0001). The main perceived benefits of using ONS drinks as PEN related to assurance of nutrient intake (89%), convenience (86%), and improvement of gut symptoms (85%). The main perceived barriers related to reduction in pleasure from eating and drinking (56%), struggling with drink storage (54%) having less energy and feeling more tired than if eating 3 solid meals daily (52%). 65% of patients would consider using ONS drinks as PEN as a maintenance treatment option. 81% of patients felt confident-very confident about consuming ONS drinks daily as PEN for three months but this dropped to 64% and 37% at 6 and 12 months, respectively. There was a significant drop in perceived ease of use of ONS drinks as PEN after the 7-day ONS study (P = 0.01). CONCLUSION Use of ONS drinks as PEN have high perceived benefits and appear to be a feasible option for short-term use of 3-6 months in CD patients. However, confidence in long-term use of ONS drinks as PEN is low mainly due to the perceived social impact. Future studies should assess longer trial periods and volume of ONS drinks to increase the validity of these findings.
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Affiliation(s)
- Katie Keetarut
- University College London Hospital NHS Foundation Trust, Department of Nutrition and Dietetics, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK.
| | - Harumi Kikuchi
- University College London, Institute for Liver and Digestive Health, UCL Division of Medicine, Upper Third Floor, Royal Free Campus, London, NW3 2PF, UK.
| | - Beth King
- University College London, Institute for Liver and Digestive Health, UCL Division of Medicine, Upper Third Floor, Royal Free Campus, London, NW3 2PF, UK.
| | - Nadine Richards
- University College London, Institute for Liver and Digestive Health, UCL Division of Medicine, Upper Third Floor, Royal Free Campus, London, NW3 2PF, UK.
| | - Miranda Lomer
- King's College London, Diabetes and Nutritional Sciences Division, 150 Stamford Street, London, SE1 9NH, UK.
| | - Konstantinos Fragkos
- University College London Hospital NHS Foundation Trust, GI Services, Ground Floor Central, 250 Euston Road, London, NW1 2PG, UK.
| | - Pinal S Patel
- University College London Hospital NHS Foundation Trust, Department of Nutrition and Dietetics, 3rd Floor East, 250 Euston Road, London, NW1 2PG, UK.
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Balart MT, Russell L, Narula N, Bajaj G, Chauhan U, Khan KJ, Marwaha AN, Ching E, Biro J, Halder S, Tse F, Marshall JK, Collins SM, Moayyedi P, Bercik P, Verdu EF, Leontiadis GI, Armstrong D, Pinto-Sanchez MI. Declining Use of Corticosteroids for Crohn's Disease Has Implications for Study Recruitment: Results of a Pilot Randomized Controlled Trial. J Can Assoc Gastroenterol 2021; 4:214-221. [PMID: 34617003 PMCID: PMC8489529 DOI: 10.1093/jcag/gwaa037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Corticosteroids (CS) have been used extensively to induce remission in Crohn’s disease (CD); however, they are associated with severe side effects. We hypothesized that the administration of an exclusive enteral nutrition (EEN) formula to CS would lead to increased CD remission rates and to decreased CS-related adverse events. We proposed to undertake a pilot study comparing EEN and CS therapy to CS alone to assess decrease symptoms and inflammatory markers over 6 weeks. Aim The overall aim was to assess study feasibility based on recruitment rates and acceptability of treatment in arms involving EEN Methods The pilot study intended to recruit 100 adult patients with active CD who had been prescribed CS to induce remission as part of their care. The patients were randomized to one of three arms: (i) standard-dose CS; (ii) standard-dose CS plus EEN (Modulen 1.5 kcal); or (iii) short-course CS plus EEN. Results A total of 2009 CD patients attending gastroenterology clinics were screened from October 2018 to November 2019. Prednisone was prescribed to only 6.8% (27/399) of patients with active CD attending outpatient clinics. Of the remaining 372 patients with active CD, 34.8% (139/399) started or escalated immunosuppressant or biologics, 49.6% (198/399) underwent further investigation and 8.8% (35/399) were offered an alternative treatment (e.g., antibiotics, surgery or investigational agents in clinical trials). Only three patients were enrolled in the study (recruitment rate 11%; 3/27), and the study was terminated for poor recruitment. Conclusion The apparent decline in use of CS for treatment of CD has implications for CS use as an entry criterion for clinical trials.
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Affiliation(s)
- M T Balart
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - L Russell
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - N Narula
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - G Bajaj
- McMaster University Medical Centre, Hamilton, ON, Canada.,Brampton Endoscopy Centre, Brampton, ON, Canada
| | - U Chauhan
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada
| | - K J Khan
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada.,St. Joseph's Health Care Centre, Hamilton, ON, Canada
| | | | - E Ching
- GI Health Centre, Burlington, ON, Canada
| | - J Biro
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - S Halder
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - F Tse
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - J K Marshall
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - S M Collins
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - P Moayyedi
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - P Bercik
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - E F Verdu
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - G I Leontiadis
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - D Armstrong
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
| | - M I Pinto-Sanchez
- Farncombe Family Digestive Health Research Institute, Hamilton, ON, Canada.,McMaster University Medical Centre, Hamilton, ON, Canada
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Poda O. Болезнь Крона у детей: актуальные аспекты диагностики и лечения согласно современным международным рекомендациям. CHILD`S HEALTH 2021; 16:75-83. [DOI: 10.22141/2224-0551.16.1.2021.226461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
В статье обобщены знания об эпидемиологических данных, клинических особенностях, современных принципах диагностики и лечения болезни Крона у детей на основе анализа литературных источников с использованием бумажных носителей и электронных баз данных PubMed, CyberLeninka, Web of Science, MedLine, The Cochrane Library. Обзор литературных источников по изучению данной патологии показывает, что на современном этапе диагностика воспалительных заболеваний кишечника, особенно у детей раннего возраста, все еще остается сложным вопросом. Обозначена проблема трудностей диагностического поиска вследствие не всегда типичного течения заболевания в детском возрасте. Приведены данные об особенностях клинического течения заболевания в зависимости от локализации патологического процесса. Автором также отдельно акцентирована важность ранней диагностики болезни Крона с целью проведения своевременного протокольного лечения и необходимость распознавания данной патологии уже на уровне первичной медицинской помощи. В статье также приведены данные Европейского общества детской гастроэнтерологии, гепатологии и питания и Европейской организации по изучению болезни Крона и колита относительно необходимого объема методов диагностики болезни Крона у детей согласно современным международным рекомендациям. Обзор освещает современные принципы лечения болезни Крона у детей, описаны основные фармакологические группы лекарственных средств, которые имеют доказательную базу эффективности в педиатрической практике. Особое внимание уделено роли полного энтерального питания как наиболее безопасного и достаточно эффективного направления стартовой терапии данной патологии у детей. В заключение автор освещает проблему дифференциальной диагностики воспалительных заболеваний кишечника в педиатрической практике.
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Morrison A, Braly K, Singh N, Suskind DL, Lee D. Differences in Nutrient Intake with Homemade versus Chef-Prepared Specific Carbohydrate Diet Therapy in Inflammatory Bowel Disease: Insights into Dietary Research. Pediatr Gastroenterol Hepatol Nutr 2021; 24:432-442. [PMID: 34557396 PMCID: PMC8443856 DOI: 10.5223/pghn.2021.24.5.432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the nutrient content consumed by children and adolescents on home-prepared versus chef-prepared specific carbohydrate diets (SCD) as therapy for inflammatory bowel disease (IBD). METHODS Dietary intake of two cohorts with active IBD initiating the SCD over 12 weeks was assessed. The home-prepared cohort received detailed guidance from dietitians on implementation of the SCD. The chef in the other cohort was knowledgeable in the SCD and prepared meals from a fixed set of recipes. Data from 3-day diet diaries at 4 different time points were collected. US Recommended Daily Allowances (RDA) were calculated for macronutrients, vitamins, and minerals. RESULTS Eight participants on the homemade SCD and 5 participants on the chef-prepared SCD were included in analysis. Mean % RDA for energy intake was 115% and 87% for homemade and chef-prepared groups (p<0.01). Mean % RDA for protein intake was 337% for homemade SCD and 216% for chef-prepared SCD (p<0.01). The homemade SCD group had higher mean % RDA values for vitamin A and iron, while the chef-prepared SCD group had higher intake of vitamins B1, B2, D, phosphorus and zinc (p<0.01 for all). CONCLUSION The SCD implemented homemade versus chef-prepared can result in significantly different intake of nutrients and this may influence efficacy of this dietary therapy. Meal preparation dynamics and the motivation of families who pursue dietary treatment may play an important role on the foods consumed and the outcomes on dietary therapy with the SCD.
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Affiliation(s)
- Alex Morrison
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Kimberly Braly
- Division of Gastroenterology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Namita Singh
- Division of Gastroenterology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - David L Suskind
- Division of Gastroenterology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Dale Lee
- Division of Gastroenterology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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Affiliation(s)
- Nathan S Rubalcava
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Mott Children's Hospital, 1540 East Hospital Drive SPC 4217, Ann Arbor, MI 48109 - 4217, USA
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Mott Children's Hospital, 1540 East Hospital Drive SPC 4217, Ann Arbor, MI 48109 - 4217, USA; Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, Ann Arbor, MI 48109, USA.
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Kaenkumchorn T, Musburger B, Suskind DL. Contemporary Dietary Therapies in Inflammatory Bowel Disease. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2021; 7:33-45. [DOI: 10.1007/s40746-021-00220-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/03/2025]
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Caio G, Lungaro L, Caputo F, Zoli E, Giancola F, Chiarioni G, De Giorgio R, Zoli G. Nutritional Treatment in Crohn's Disease. Nutrients 2021; 13:1628. [PMID: 34066229 PMCID: PMC8151495 DOI: 10.3390/nu13051628] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) which can affect any part of the whole gastrointestinal tract (from mouth to anus). Malnutrition affects 65-75% of CD patients, and it is now well acknowledged that diet is of paramount importance in the management of the disease. In this review, we would like to highlight the most recent findings in the field of nutrition for the treatment of CD. Our analysis will cover a wide range of topics, from the well-established diets to the new nutritional theories, along with the recent progress in emerging research fields, such as nutrigenomics.
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Affiliation(s)
- Giacomo Caio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital-Harvard Medical School, Boston, MA 02114, USA
| | - Lisa Lungaro
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Fabio Caputo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Eleonora Zoli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
| | - Fiorella Giancola
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
| | - Giuseppe Chiarioni
- Division of Gastroenterology of the University of Verona, A.O.U.I. Verona, 37126 Verona, Italy;
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Giorgio Zoli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (L.L.); (F.C.); (E.Z.); (F.G.); (R.D.G.)
- Center for the Study and Treatment of Chronic Inflammatory Intestinal Diseases (IBD) and Gastroenterological Manifestations of Rare Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Center for the Study and Treatment of Alcohol-Related Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Department of Internal Medicine, Santissima Annunziata Hospital, Cento (Ferrara), University of Ferrara, 44042 Ferrara, Italy
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Burgess D, Herbison K, Fox J, Collins T, Landorf E, Howley P. Exclusive enteral nutrition in children and adolescents with Crohn disease: Dietitian perspectives and practice. J Paediatr Child Health 2021; 57:359-364. [PMID: 33015922 DOI: 10.1111/jpc.15220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 09/20/2020] [Indexed: 11/30/2022]
Abstract
AIM In newly diagnosed paediatric Crohn disease, exclusive enteral nutrition (EEN) is recommended as a first-line treatment for remission induction. However, EEN protocols vary internationally. The development of best practice protocols may make it easier to make definitive conclusions about optimal EEN therapy, and may improve patient outcomes. This study aims to determine the variations in current dietitian EEN practice within Australia and New Zealand (NZ) to inform a common EEN protocol in the future, and to gather perspectives on the need for nutrition resources for patients with inflammatory bowel disease (IBD). METHODS A questionnaire was created and emailed to paediatric dietitians working with gastroenterologists in public and private paediatric centres in Australia and NZ. Respondents were invited to provide details of their perspectives of EEN therapy and protocol details. RESULTS Eighteen paediatric dietitians responded to the questionnaire, 10 from Australia and 8 from NZ. There was clear consensus between respondents on the duration of EEN being 6 and 8 weeks, the need for close dietitian supervision while on EEN, and the method of food reintroduction. There was lack of consensus between dietitians regarding permitted concomitant foods whilst on EEN. This study also determined a potential benchmarking relationship between IBD dietitian hours and numbers of patients on EEN per year in a centre. CONCLUSIONS Paediatric dietitians in Australia and NZ are mostly aligned in their practice of EEN. Development of a standard EEN protocol, and patient IBD resources, will further align practice and allow for greater research possibilities.
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Affiliation(s)
- Deirdre Burgess
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kim Herbison
- Department of Nutrition and Dietetics, Starship Children's Hospital, Auckland, New Zealand
| | - Julia Fox
- Department of Nutrition and Dietetics, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Tanya Collins
- Department of Nutrition and Dietetics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Emma Landorf
- Department of Nutrition and Dietetics, Womens and Children's Hospital, Adelaide, South Australia, Australia
| | - Peter Howley
- School of Mathematical and Physical Sciences/Statistics, University of Newcastle, Newcastle, New South Wales, Australia
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Verburgt CM, Ghiboub M, Benninga MA, de Jonge WJ, Van Limbergen JE. Nutritional Therapy Strategies in Pediatric Crohn's Disease. Nutrients 2021; 13:212. [PMID: 33450982 PMCID: PMC7828385 DOI: 10.3390/nu13010212] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/12/2022] Open
Abstract
The increase in incidences of pediatric Crohn's Disease (CD) worldwide has been strongly linked with dietary shifts towards a Westernized diet, ultimately leading to altered gut microbiota and disturbance in intestinal immunity and the metabolome. Multiple clinical studies in children with CD have demonstrated the high efficacy of nutritional therapy with exclusive enteral nutrition (EEN) to induce remission with an excellent safety profile. However, EEN is poorly tolerated, limiting its compliance and clinical application. This has spiked an interest in the development of alternative and better-tolerated nutritional therapy strategies. Several nutritional therapies have now been designed not only to treat the nutritional deficiencies seen in children with active CD but also to correct dysbiosis and reduce intestinal inflammation. In this review, we report the most recent insights regarding nutritional strategies in children with active CD: EEN, partial enteral nutrition (PEN), Crohn's disease exclusive diet (CDED), and CD treatment-with-eating diet (CD-TREAT). We describe their setup, efficacy, safety, and (dis)advantages as well as some of their potential mechanisms of action and perspectives. A better understanding of different nutritional therapeutic options and their mechanisms will yield better and safer management strategies for children with CD and may address the barriers and limitations of current strategies in children.
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Affiliation(s)
- Charlotte M. Verburgt
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (C.M.V.); (M.G.); (M.A.B.)
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, 1105 BK Amsterdam, The Netherlands;
| | - Mohammed Ghiboub
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (C.M.V.); (M.G.); (M.A.B.)
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, 1105 BK Amsterdam, The Netherlands;
| | - Marc A. Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (C.M.V.); (M.G.); (M.A.B.)
| | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, 1105 BK Amsterdam, The Netherlands;
- Department of Surgery, University of Bonn, 53127 Bonn, Germany
| | - Johan E. Van Limbergen
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (C.M.V.); (M.G.); (M.A.B.)
- Tytgat Institute for Liver and Intestinal Research, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers, University of Amsterdam, 1105 BK Amsterdam, The Netherlands;
- Department of Pediatrics, Dalhousie University, Halifax, NS B3K 6R8, Canada
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Herrador-López M, Martín-Masot R, Navas-López VM. EEN Yesterday and Today … CDED Today and Tomorrow. Nutrients 2020; 12:nu12123793. [PMID: 33322060 PMCID: PMC7764146 DOI: 10.3390/nu12123793] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
The treatment of Pediatric Crohn’s Disease (CD) requires attention both to achieve mucosal healing and to optimize growth, while also maintaining proper bone health. Exclusive Enteral Nutrition (EEN) is recommended as first-line treatment in luminal CD. The therapeutic mechanisms of EEN are being discovered by advances in the study of the gut microbiota. Although the total exclusion of a normal diet during the time of EEN continues to be of high importance, new modalities of dietary treatment suggest a successful future for the nutritional management of CD. In this sense, Crohn’s Disease Exclusion Diet (CDED) is a long-term strategy, it apparently acts on the mechanisms that influence the appearance of inflammation (reducing dietary exposure to products negatively affecting the microbiota), but does so using specific available whole foods to achieve this goal, increases the time of clinical remission and promotes healthy lifestyle habits. The development of CDED, which partly minimizes the problems of EEN, has enabled a turnaround in the treatment of pediatric CD. This review highlights the role of enteral nutrition in the treatment of Crohn’s disease with special emphasis on newer dietary modalities such as CDED.
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Parent Perspectives on Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2020; 71:744-748. [PMID: 32910623 DOI: 10.1097/mpg.0000000000002847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Exclusive enteral nutrition (EEN) is infrequently used in the United States but is an effective treatment for pediatric Crohn disease (CD). Limited data exists regarding patient and parent perspectives on this treatment modality. The aim of this study was to determine parent and provider perspectives regarding EEN and understand parent-cited barriers to its use. METHODS We surveyed the parents/guardians of children ages 1 through 17 with CD in our institution regarding EEN. Healthcare provider perspectives regarding reason for stopping EEN and those cited by survey respondents were compared using retrospective chart review. RESULTS One hundred fifteen (62.5%) out of 184 recipients responded to the survey. Ninety percentage of respondents had heard of EEN but of these, 26% had not discussed it with their gastroenterologist. Thirty-eight patients (33%) were treated in the past and 15 (13%) were currently on EEN. Common barriers cited by current EEN users were cost/finances and difficult social situations. Of the children who stopped EEN, most did so as parents felt it was not working (n = 14, 37%). In these cases, their primary gastroenterologist cited treatment failure for 4 cases and nonadherence for 6. CONCLUSIONS Despite the efficacy of EEN and interest in dietary treatments by patients with CD, there are many barriers surrounding effective communication and successful implementation of dietary therapies. Future research is needed regarding patient-physician communication, cost mitigation, and coping with the social limitations of dietary therapies.
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Gkikas K, Gerasimidis K, Milling S, Ijaz UZ, Hansen R, Russell RK. Dietary Strategies for Maintenance of Clinical Remission in Inflammatory Bowel Diseases: Are We There Yet? Nutrients 2020; 12:E2018. [PMID: 32645980 PMCID: PMC7400838 DOI: 10.3390/nu12072018] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
The etiopathogenesis of Inflammatory bowel disease (IBD) is a result of a complex interaction between host immune response, the gut microbiome and environmental factors, such as diet. Although scientific advances, with the use of biological medications, have revolutionized IBD treatment, the challenge for maintaining clinical remission and delaying clinical relapse is still present. As exclusive enteral nutrition has become a well-established treatment for the induction of remission in pediatric Crohn's disease, the scientific interest regarding diet in IBD is now focused on the development of follow-on dietary strategies, which aim to suppress colonic inflammation and delay a disease flare. The objective of this review is to present an extensive overview of the dietary strategies, which have been used in the literature to maintain clinical remission in both Crohn's disease and Ulcerative colitis, and the evidence surrounding the association of dietary components with clinical relapse. We also aim to provide study-related recommendations to be encompassed in future research studies aiming to investigate the role of diet during remission periods in IBD.
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Affiliation(s)
- Konstantinos Gkikas
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; (K.G.); (K.G.)
| | - Konstantinos Gerasimidis
- Human Nutrition, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow G31 2ER, UK; (K.G.); (K.G.)
| | - Simon Milling
- Institute for Infection, Immunity and Inflammation, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Umer Z. Ijaz
- Civil Engineering, School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Richard Hansen
- Department of Paediatric Gastroenterology, Royal Hospital for Children, Glasgow G51 4TF, UK;
| | - Richard K. Russell
- Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
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Effect of Exclusive Enteral Nutrition and Corticosteroid Induction Therapy on the Gut Microbiota of Pediatric Patients with Inflammatory Bowel Disease. Nutrients 2020; 12:nu12061691. [PMID: 32517036 PMCID: PMC7352362 DOI: 10.3390/nu12061691] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction: Exclusive enteral nutrition (EEN) and corticosteroids (CS) are effective induction therapies for pediatric Crohn’s Disease (CD). CS are also therapy for ulcerative colitis (UC). Host–microbe interactions may be able to explain the effectiveness of these treatments. This is the first prospective study to longitudinally characterize compositional changes in the bacterial community structure of pediatric UC and CD patients receiving EEN or CS induction therapy. Methods: Patients with diagnoses of CD or UC were recruited from McMaster Children’s Hospital (Hamilton, Canada). Fecal samples were collected from participants aged 5–18 years old undergoing 8 weeks of induction therapy with EEN or CS. Fecal samples were submitted for 16S rRNA sequencing. The Shannon diversity index and the relative abundance of specific bacterial taxa were compared using a linear mixed model. Results: The clustering of microbiota was the highest between patients who achieved remission compared to patients still showing active disease (p = 0.029); this effect was independent of the diagnosis or treatment type. All patients showed a significant increase in Shannon diversity over the 8 weeks of treatment. By week 2, a significant difference was seen in Shannon diversity between patients who would go on to achieve remission and those who would not. Conclusion: The gut microbiota of pediatric UC and CD patients was most influenced by patients’ success or failure to achieve remission and was largely independent of the choice of treatment or disease type. Significant differences in Shannon diversity indices occurred as early as week 2 between patients who went on to achieve remission and those who continued to have active disease.
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Limketkai BN, Gordon M, Mutlu EA, De Silva PS, Lewis JD. Diet Therapy for Inflammatory Bowel Diseases: A Call to the Dining Table. Inflamm Bowel Dis 2020; 26:510-514. [PMID: 31819987 DOI: 10.1093/ibd/izz297] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Indexed: 12/13/2022]
Abstract
There is vigorous interest among patients, caregivers, clinicians, and scientists to identify useful dietary interventions for inflammatory bowel diseases (IBD). Through the Cochrane Collaboration, we recently performed a systematic review and meta-analysis of dietary interventions for the induction or maintenance of remission in Crohn's disease (CD) and ulcerative colitis (UC) to assess the latest state of research. The current quality of evidence was formally graded to be low or very low for various methodological reasons, such as small sample sizes, heterogeneity among studies, and incomplete reporting. There are nonetheless emerging observational studies that progressively advance our knowledge and provide hope for a role of diet among traditional therapies to improve inflammation and symptoms. Further investments and concerted efforts in research are needed to significantly move the needle in identifying effective dietary therapies for IBD.
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Affiliation(s)
- Berkeley N Limketkai
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, California, USA
| | - Morris Gordon
- University of Central Lancashire, Preston, United Kingdom
| | - Ece A Mutlu
- Section of Gastroenterology, Hepatology & Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Punyanganie S De Silva
- Center for Crohn's and Colitis, Division of Gastroenterology, Hepatology & Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James D Lewis
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Day AS. Chronic Diarrhoea in Infants and Children: Approaching and Managing the Problem. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:1-11. [DOI: 10.1007/s40746-020-00187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
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