Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children

Background: The optimal treatment of acute Crohn's disease in children rema ins controversial. In adults, steroid therapy has been shown to be superior to exclusive enteral nutrition. However, enteral nutrition is effective at inducing a remission in many children with acute Crohn's disease. Steroid usage in children has been associated with adverse side effects, particular ly with delayed growth and pubertal development. Methods: Randomized clinical trials comparing exclusive en rd nutrition wit h corticosteroids were identified. Two independent reviewers extracted data from selected studies. Studies were assessed for heterogeneity and relativ e risks for remission induction with enteral nutrition were obtained. Sensi tivity analyses were pet-formed in partially randomized studies. Estimates were made of the number of studies needed to overturn the current result. O ther outcome measures were qualitatively assessed. Results: in five randomized clinical trials comprising 147 patients, entera l nutrition was as effective as corticosteroids at inducing a remission (BR = 0.95 [95% confidence interval 0.67, 1.34]). Addition of two further nonr andomized trials did not significantly alter the result. A minimum of 10 fu rther studies, equal in size and outcome to the largest reported pediatric trial to date (n = 68, RR = 0.84), would be required to demonstrate a signi ficant benefit of steroid therapy over enteral nutrition. Conclusions: There is no difference in efficacy between enteral nutrition a nd corticosteroid therapy in the treatment of acute Crohn's disease in chil dren. Improved growth and development, without the side effects of steroid therapy, make enteral nutrition a better choice for first-line therapy in c hildren with active Crohn's disease.