Dr Scott Nightingale, Michael DiRienzo, Deirdre Burgess and Liz Notaras
Enhancing uptake and effectiveness of enteral nutritional therapy in children and adolescents with active Crohn’s disease
Team Leader: Dr Scott Nightingale Staff Specialist Paediatric Gastroenterologist, Kaleidoscope
Crohn’s disease (CD) is the commonest form of inflammatory bowel disease (IBD) in childhood, and is a chronic (often lifelong) disease characterised by gastrointestinal inflammation of unknown cause. Approximately one quarter of all people who develop CD will do so during childhood and adolescence. CD in childhood is often more aggressive than that in adults and adversely affects normal growth and development of affected children. Furthermore, there is often a significant psychological impact for both the child/adolescent and their families, affecting family and peer relationships, quality of life and subsequently, adherence to therapy.
There is strong evidence from randomised controlled trials that exclusive enteral nutritional therapy (EEN, ie taking only a diet of a low-residue formula and no other foods) for a period of around 2 months is as effective as therapy with corticosteroid drugs in achieving disease remission in children with active Crohn's disease1. Additional benefits of EEN are improvement in growth parameters, nutritional status, and avoidance of the significant toxicity associated with corticosteroid drugs. Despite the equivalent efficacy and additional benefits, uptake and completion of EEN therapy is low in paediatric gastroenterology units worldwide.
Aim: To develop and implement an effective, sustainable multidisciplinary approach to enhancing uptake and effectiveness of EEN therapy in children and adolescents with active CD within our service. We anticipated that this would improve a range of multidimensional outcomes for these children and adolescents as well as their families.