Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Enteral nutrition · Inflammatory bowel disease ·

Growth · Treatment

Key Messages

• Exclusive enteral nutrition (EEN) is an alternative to
  drug therapy in inducing remission in active Crohn
  disease


• In the treatment of active Crohn disease either ele-
  mental or polymeric formulae should be provided
  as the sole source of nutrition for 6–8 weeks


• Supplementary enteral nutrition will facilitate
  weight gain and linear growth and may help main-
  tain clinical remission


• Further research is needed to clarify the mecha-
  nisms of action of EEN as primary therapy
  © 2015 S. Karger AG, Basel

Introduction

Enteral feeding of formulated food can be used to
correct or prevent malnutrition in inflammatory
bowel disease [1]. Exclusive enteral nutrition
(EEN) implies the use of an artificial formula for

the provision of 100% of daily energy as well as

macro- and micronutrient requirements in lieu of

a regular diet. EEN is an alternative to corticoste-

roids for active Crohn disease, employed more of-

ten in children than adults, and more widely in

Europe than in North America [2]. Its efficacy is

supported by data from randomized controlled

trials versus corticosteroids, and from compara-

tive trials of different formulae [3]. The mecha-

nism of action remains conjectural but may in-

volve alteration in the enteric microflora [4].

Treatment algorithms for Crohn disease are

changing. Corticosteroids alleviate symptoms

but seldom heal the intestine. In Europe, EEN is

endorsed as the primary therapy of new-onset

Crohn disease, with thiopurines introduced early

for maintenance therapy. Recent guidelines have

been put forth to enhance the use of enteral nutri-

tion in the management of paediatric Crohn dis-

ease in North America [5]. The support of a mul-

tidisciplinary team of nurses and dieticians is es-

sential [5, 6]. This chapter focuses on the use of

EEN as the primary therapy of intestinal inf lam-

mation and aims to provide a practical guide for

its implementation.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 239–243
DOI: 10.1159/000360345

3.18 Enteral Nutrition for Paediatric Inflammatory

Bowel Disease

Marialena Mouzaki  Anne Marie Griffiths

3