Pediatric Nutrition in Practice

242 Mouzaki  Griffiths

minimum of 6 weeks, longer if ideal weight has
not been reached yet.

Reintroduction of Solid Food
Foods are usually reintroduced gradually. It may
be prudent, particularly if there are intestinal
strictures, to offer a low-fibre diet initially follow-
ing completion of the enteral nutrition regimen.
A sample order of food reintroduction is given in
table 2.

Facilitation of Linear Growth

Impairment of linear growth commonly compli-
cates Crohn disease. The major contributing fac-
tors are the direct growth-inhibiting effects of
proinflammatory cytokines produced by the in-
flamed intestine and chronic undernutrition [14].
Inappropriate use of chronic corticosteroid ther-
apy will also impede linear growth. Other treat-
ment strategies, which induce mucosal healing,
will be associated with reduced cytokine produc-
tion and will facilitate growth as long as the con-
trol of inflammation can be sustained. Resump-
tion of normal linear growth is a marker of thera-
peutic success. Conversely, if a child merely gains
weight but does not grow normally in height, it
can be assumed that the inflamed intestine is not
healing, and that other anti-inflammatory inter-
ventions must be adopted.

Maintenance of Clinical Remission

Symptoms tend to recur following the cessation of

enteral nutrition. In most studies, 60–70% of pa-

tients experience a symptomatic relapse within 12

months of enteral nutrition [3]. Two nutritional

strategies can be considered to maintain remis-

sion: firstly, ‘cyclical EEN’, meaning administra-

tion of a liquid diet and avoidance of regular food

1 month out of 4, or, secondly, ‘supplementary en-

teral nutrition’. The latter, which has been em-

ployed primarily if nocturnal NG feeding is used,

involves continuation of such feeding 4–5 times

weekly as supplement to an unrestricted ad libitum

daytime diet [15]. In Europe, the most common

strategy to maintain clinical remission following

EEN is institution of immunomodulatory drugs.

Conclusions

• Exacerbations of Crohn disease, particularly
  involving the small intestine, may be treated
  with 4–6 weeks of EEN


• Use of palatable polymeric formulae may
  avoid the need for nocturnal NG infusion


• Because relapse is common following cessa-
  tion of enteral nutrition, strategies to maintain
  remission must be planned


• Sustained, normal linear growth is a marker of
  success of therapy

5 Critch J, Day AS, Otley A, et al: Use of

enteral nutrition for the control of intes-

tinal inflammation in pediatric Crohn

disease. J Pediatr Gastroenterol Nutr

2012; 54: 298–305.

6 Buchanan E, Gaunt WW, Cardigan T, et

al: The use of exclusive enteral nutrition

for induction of remission in children

with Crohn’s disease demonstrates that

disease phenotype does not influence

clinical remission. Aliment Pharmacol

Ther 2009; 30: 501–507.

References

1 Voitk AJ, Echave V, Feller JH, et al: Ex-
perience with elemental diet in the treat-
ment of inflammatory bowel disease: is
this primary therapy? Arch Surg 1973;
107: 329–333.
2 Levine A, Milo T, Buller H, Markowitz J:
Consensus and controversy in the man-
agement of pediatric Crohn disease: an
international survey. J Pediatr Gastroen-
terol Nutr 2003; 36: 464–469.

3 Zachos M, Tondeur M, Griffiths AM: En-

teral nutritional therapy for induction of

remission in Crohn’s disease. Cochrane

Database Syst Rev 2007; 1:CD000542.

4 Leach ST, Mitchell HM, Eng WR, Zhang

L, Day AS: Sustained modulation of in-

testinal bacteria by exclusive enteral

nutrition used to treat children with

Crohn’s disease. Aliment Pharmacol

Ther 2008; 28: 724–733.

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