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Sara Nóbrega1, Bénédicte Pigneur2, Frank Ruemmele2

1 - Unidade de Gastrenterologia-hepatologia e Nutrição Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar Lisboa Central, EPE
2 - Sérvice de Gastroentérologie-hépatologie et nutrition pédiatrique, Hôpital Necker - Enfants Malades, Paris, France, Université Paris-Descartes

- Apresentado sob a forma de comunicação oral na ESPGHAN (European Society for Paediatric Gastroenterology Hepatology and Nutrition), 25-28/5/2016 em Atenas

Introduction: Enteral nutrition (EN) is a well-established treatment in pediatric Crohn's disease (CD). There are reports of EN as maintenance therapy, but usually on top of other treatment or after surgically induced remission. The aim of our study was to test feasibility and efficacy of cyclic exclusive EN as sole maintenance therapy.
Methods: Nine patients with active luminal paediatric CD, followed at Necker Hospital between 2012-2014 were included in this prospective pilot study. After 8 weeks of exclusive EN with Modulen IBD, patients who came into complete CRP-negative remission were proposed to continue cyclic EEN therapy as sole treatment in an open manner. Patients were followed on a fixed scheme: T0 refers to time of study inclusion when diagnosis of CD was made, T1 end of induction of remission, T2 3 months after induction of remission and T3 9 months after induction of remission.
Results: At the end of the induction of remission period, all patients were in deep remission. At month 3 and 9 follow-up visit, 67% of patients were on clinical remission, with wPCDAI 8,1 (SD=8,7) and 6,7 (SD=8,8), respectively. Biological scores markedly improved with mean sedimentation rate 31 mm/h (SD=14,2) at T0 and 12,7 mm/h (SD=8,4) at T3 (p=0,014) and albumin normalization with 33,8 g/l (SD=3,8) at T0 vs 41 g/l (SD=4,9) at T3 (p=0,014). Patients presented catch up growth with improvement of their anthropometric measurements at T1 and stabilization thereafter.
Conclusion: This study demonstrates for the first time prolonged clinical, biological remission and improved growth in pediatric CD patients treated with cyclic enteral nutrition. Cyclic EN can be an efficacious non pharmacological treatment of Crohn's disease potentially acting ahead of the inflammatory cascade in intestinal mucosa. A sufficiently power randomized controlled trial is currently conducted by the GETAID pédiatrique to confirm these pilot data.

Palavras-chave: Crohn disease, enteral nutrition