Kan total enteral nutrition ersätta steroidbehandling vid pediatrisk Morbus Crohn?
Sahlgrenska Academyat University of GothenburgDepartment of internal medicine and clinical nutritionAbstractTitle: Can exclusive enteral nutrition replace steroid treatment in pediatric Morbus Crohn?Author: Hanna Rymark Lehnér and Josephine PetterssonSupervisor: Mette AxelsenExaminer: Anna WinkvistProgramme: Dietician study programme, 180/240 ECTSType of paper: Examination paper, 15 hpDate: May 23, 2012Background: Morbus Crohn is a chronic inflammatory bowel disease which periodically causes great suffering for the patient. There is solid scientific evidence that treatment with steroids effectively induces and preserves remission. However, side effects are many and a great risk for stunted growth and skeletal development exists in children. A widespread view is that exclusive enteral nutrition is as effective as steroids in pediatric Crohn´s. This would mean a reduced risk for serious side effects. At the same time, the child?s nutritional intake is ensured and chances for a normal growth and body development improves.Objective: To determine if nutrition therapy in the form of exclusive enteral nutrition can lead to remission in the same extent as steroids in the treatment of pediatric Crohn´s disease. The issues were to determine if exclusive enteral nutrition is an equal choice of primary treatment compared to steroids, with regards to remission/reduction of disease-activity, growth and side effects.Search strategy: Systematic searches were conducted during February 2012 in the scientific databases Pubmed and Scopus. Keywords used were Crohn disease, enteral nutrition, remission, children and diet.Selection criteria: Original articles in Swedish and English which compared the effect of treatment between exclusive enteral nutrition and steroids for children between 0-18 years with active Crohn´s. Only randomised controlled human studies with steroids as a control were included. Studies which also covered Ulcerous colitis and/or parenteral nutrition were excluded.Data collection and analysis: There were four articles included and audited according to SBU´s template ?granskningsmall för randomiserad kontrollerad prövning?. The total strength of evidence were assessed according to ?sammanfattande evidensformulär?, which is based on GRADE.Main results: Total enteral nutrition is as effective as steroids for inducing remission in pediatric crohn´s (moderate evidence +++). Total enteral nutrition as primary treatment leads to a better growth compared to steroid treatment (limited evidence ++). Exclusive enteral nutrition also seems to cause less side effects compared to steroids (moderate evidence +++).Conclusions: Based on this review the scientific evidence suggests that exclusive enteral nutrition is a good alternative to steroids as a primary method of treatment in pediatric Crohn´s.