Inflammatory Bowel Disease

Discussing the latest advances in Crohn’s disease and ulcerative colitis

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June 27, 2014

Exclusive Enteral Nutrition and Pediatric Crohn’s Disease

By Margaret Shepard, Communications Specialist

Jeanne Tung, M.D., a pediatric gastroenterologist at Mayo Clinic, discusses a recently published article in Alimentary Pharmacology & Therapeutics about exclusive enteral nutrition (EEN) in pediatric Crohn’s disease. The results show EEN was associated with remission for pediatric Crohn’s disease.


What is EEN? For several weeks to months, a patient drinks formula such as Pediasure, Ensure, or Boost, instead of eating a regular diet. They gradually return to a regular diet. Sometimes patients find it hard to drink the number of cans or boxes of formula they need for that day so they learn to place a feeding tube down. A feeding tube is a way to avoid using steroids during flares. Steroids have side effects such as suppressing the immune system, causing weight gain, moodiness, and osteoporosis.

In studies of adult Crohn's patients, EEN didn't work as well as steroids. This may be due to patients dropping out of the study because they didn't like the taste of the formula. In the pediatric population, patients are more likely to use tube feedings so they don't have to taste the formula. In pediatric studies, the formulas worked as well as steroids, without the side effects. Compared to steroids, studies have shown mucosal healing, which means improvement in the tissue. Studies have also shown improvement in inflammatory markers such as the sed rate and c-reactive protein.

In this current study, researchers at a children's hospital in Germany looked at their experience with EEN for pediatric Crohn's disease.  The main purpose was to look at how effective EEN was in newly diagnosed Crohn's patients and those who used it during a relapse. The researchers looked back at their records for children with Crohn's disease that had received EEN. They excluded patients that either received steroids in the last three months or taken an anti-TNF agent, such as Remicade, Humira, or Cimzia.

To judge if the patients responded to EEN, they used an activity index designed for pediatric Crohn's disease. They also measured blood levels of inflammatory markers and checked stool samples. The researchers identified 52 patients to follow for at least a year and up to six years.

After EEN, 92% of the patients were in remission. There was modest weight gain and sed rates became normal. Some of the patients went onto a second period of EEN when the Crohn's disease flared. In that second period, fewer patients, 77%, were in remission 12 weeks later. In the group of patients that were just diagnosed, about 2/3 of them were on Azathioprine or 6-MP and were in remission one year later and stayed in remission when followed out to six years later. The researchers did notice about 40% of patients within six years still had to go on an anti-TNF agent. In this study, younger patients seemed to do better.

EEN was highly affective at inducing remission in children with newly diagnosed Crohn's disease. It was not as effective for patients who had a flare. EEN doesn't replace the typical medication such as Azathioprine, Methotrexate, or Remicade. It's meant to replace steroids and side effects.

Look for a more detailed video on EEN in the future.

Read the full study online here.

For more information on IBD, visit

Dr. Tung is a pediatric gastroenterologist at Mayo Clinic.

Tags: Alimentary Pharmacology & Therapeutics, Crohn's disease, EEN, exclusive enteral nutrition, Jeanne Tung, pediatric Crohn's disease, Study Findings

So, I get what EEN is, what it does, what it helps us avoid (steroids and their side effects) but what I don't understand is what mechanism are we targeting with this treatment? Why THIS treatment exactly or why Pediasure or similar formula?
Like are we trying to remove any inflammatory substances? Are we trying to starve out certain types of gut bacteria and which ingredients do that? Are we trying to feed certain types of gut bacteria and what ingredients do that? Are we trying to overcome what may have been poor nutrition by the patient? Is it a matter of giving the gut a rest from regular food by only feeding overnight? Are we trying to induce gene expression of certain alleles in the patient that will improve conditions and which ingredients do that? Are we trying to induce gene expression in the gut bacteria to improve the conditions and which ingredients do that? I mean, what exactly are we targeting with something like ensure or boost or Nestle, etc?

Because to me, when one looks at the ingredients in most of these, some of them make sense, but some of them don't (carageenan, corn oil). The literature reads like "Hey we tried giving people this nutrient rich syrup, and it worked like 70-80% of the time" but there's no explanation as to what mechanisms this specific cocktail is targeting and why.

Is that information somewhere? I can see the efficacy in the stats, I can see they recorded a lot of helpful biomarkers as part of the study, but I just can't see what thought was put into the ingredients list. Because if its just a matter of putting the right ingredients into the shake, then one would imagine we could skip the shake salesman and put the right ingredients directly into our meals. Any thoughts before I put my child on this regimen?

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