R Cawdron¹, R Issenman¹, K Jacobson², M Thompson³, C Nahmias³

Department of ¹Medicine, ³Nuclear Medicine, McMaster University, Hamilton, Ontario; ²Division of Gastroenterology, Children’s and Women Hospital, Vancouver, British Columbia, Canada

Background: Enteral nutrition (EN) is advocated as a treatment for active pediatric Crohn’s disease (CD). However, its mode of action remains poorly understood, making it difficult to identify candidates who may respond more favourably to EN. As a valid measure of intestinal inflammation, the non-invasive FDG-PET procedure may aid predicting response to EN. Aim: To identify predictors of response to EN therapy. Methods: CD patients, aged 8-17, with Crohn’s disease activity index (CDAI) scores >150, and without recent medication changes or EN contraindications, were recruited prospectively. The 28-day EN therapy was formulated for ileal and colonic CD. CDAI scores, serological and FDG-PET results were recorded immediately before initiating EN, and at exit. FDG-PET produced positive or negative reports of inflammation for the small bowel, and each large bowel segment. CDAI scores were used in stepwise multiple regression analysis and paired t-tests. Results: Of 12 patients, mean aged 13.7±2.4 years, 75% were male. Half had symptoms for >1 year and mean months since onset was 24.2±16.8. Mean CDAI scores at entry (294.6±51.6) were significantly (p<0.05) decreased by exit (125.1±60.3). Exit scores were best predicted by entry scores (ß= 0.9, 95%CI 0.6-1.2 p<0.001) and, an absence of inflammation in the ascending colon (ß= 84.2; 95% CI -122.2- -46.1, p<0.001) and active recto-sigmoid disease (ß=-44.6; 95% CI -84.8- -4.4, p<0.005), at entry. Likewise, pre-post therapy CDAI differences also indicated that inflammation in the ascending colon was a predictor of poorer response (ß= -100.3; 95% CI -129.3 - -71.4, p<0.001), while recto-sigmoid involvement predicted increased response (ß =58.6 95% CI 26.1-91.1, p<0.01). Both models explained approximately 88% of variation (p<0.001). Age, sex, time since onset, serological levels, and small bowel involvement did not significantly affect response to EN. Conclusion: Inflammation in the recto-sigmoid region, and its absence in the ascending colon at entry, were predictors of better response to EN. Demographic and serological variables did not significantly affect CDAI score response. EN significantly reduced moderate CD activity in children with colonic disease. Distal inflammation appeared to respond more favourably to EN therapy than more proximal colonic Crohn’s.

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