CHILDHOOD CROHNS-DISEASE AND THE EFFICACY OF ENTERAL DIETS

Enteral diets, both elemental and, more recently, polymeric (whole pro tein), are used as primary therapy in Crohn's disease and can induce d isease remission without the concomitant use of immunosuppressive drug s. Controlled trials comparing enteral nutrition with corticosteroid t herapy have given mixed results but suggest, at least in children, tha t they are as effective as corticosteroids in inducing remission. Ther e is no clear consensus as to which dietary therapy is best. Elemental diets do not seem to be superior to polymeric whole protein-based die ts, although further work is necessary. The effect of enteral diets do es not seem to be related to the site of intestinal inflammation. Ente ral nutrition is particularly appropriate in children and adolescents with Crohn's disease, improving nutrition and promoting growth and pub ertal development, and avoiding the systemic toxicity of corticosteroi d therapy. Most centers will use it as a first line of treatment. Supp lementary enteral nutrition after primary therapy and remission induct ion may be associated with the prolongation of remission and promotion of linear growth. Pathways by which enteral diets may affect mucosal inflammation are discussed. Enteral diets may inhibit intestinal immun e responses by reducing the number of cytokine-producing cells. Entera l nutrition may also boost immunosuppressive pathways, which then endo genously suppress ongoing inflammation. Enteral diets may promote epit helial healing and reepithelialization of Crohn's ulcers and may also reduce the bacterial load in the small bowel. (C) Elsevier Science Inc . 1998.