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Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn¡¯s disease: a meta-analysis 
Exclusive enteral nutrition versus corticosteroids for treatment of pediatric Crohn¡¯s disease: a meta-analysis
  Yu Yu, Kang-Chen Chen, Jie Chen
 [Abstract] [Full Text] [PDF]   Pageviews: 1631 Times
Background: Many studies have examined the effects of exclusive enteral nutrition (EEN) in children with Crohn¡¯s disease (CD), but corticosteroids are considered a superior therapy and are frequently used in China. This meta-analysis aims to compare the efficacy of EEN with corticosteroids in treating pediatric CD.
Methods: A comprehensive retrieval from medical databases, including PubMed, EMBASE, MEDLINE, Web of Science, Wanfang data, VIP and CNKI, was performed using the search terms ¡°diet therapy¡±, ¡°exclusive enteral nutrition¡±, ¡°Crohn¡¯s disease¡±, ¡°inflammatory bowel diseases¡±, ¡°child¡± and ¡°pediatrics¡± from January 1990 to April 2017.
Results: We included 18 studies from 1329 identified sources in this meta-analysis. EEN was as effective as corticosteroids in inducing remission rate of children suffering from CD (OR = 1.35; 95% CI 0.90, 2.10; P = 0.14). Nevertheless, patients who received EEN were more likely to achieve both endoscopic mucosal healing (OR = 5.24; 95% CI 2.06, 13.37; P = 0.0005) and histological mucosal healing (OR = 4.78; 95% CI 1.89, 12.08; P = 0.0009) than those who received corticosteroids; the Pediatric Crohn¡¯s Disease Activity Index was lower [mean difference (MD) = − 3.67; 95% CI − 4.91, − 2.43] and weight gain was higher (MD = 1.92; 95% CI 0.02, 3.83; P = 0.05) in those patients who received EEN than in those who received corticosteroids. No difference was found in relapse rate (OR = 0.57; 95% CI 0.25, 1.29; P = 0.18), height for age or body mass index between the patients treated with EEN and corticosteroids at the 1-year end point.
Conclusions: This meta-analysis reveals that there is no significant difference between EEN and corticosteroids in the efficacy of inducing remission rate of CD in a pediatric population, but EEN is superior to corticosteroids in improving short-term mucosal inflammation and reducing the PCDAI index.
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