DOI QR코드

DOI QR Code

Exclusive Enteral Nutrition for the Treatment of Pediatric Crohn's Disease: The Patient Perspective

  • Received : 2022.10.11
  • Accepted : 2023.02.12
  • Published : 2023.05.15

Abstract

Crohn's disease (CD) is a chronic, incurable and relapsing disease involving any part of the gastrointestinal tract and exclusive enteral nutrition (EEN) is first-line therapy. Few studies have examined the patient experience of EEN. The aim of this study was to assess the child's experiences of EEN, to identify problematic themes and understand the child's mindset. Children with CD who previously completed EEN were recruited to complete a survey. All data were analyzed using Microsoft Excel and reported as N (%). Forty-four children (mean age 11.3 years) consented to participate. Sixty-eight percent of children reported limited formula flavors as the most challenging aspect and 68% of children identified 'support' to be important. This study highlights the psychological impact of chronic disease and its therapies on children. Providing adequate support is essential to insure EEN is successful. Further studies are required to determine psychological support strategies for children taking EEN.

Keywords

Acknowledgement

Funding for this study was granted by the Canterbury Medical Research Foundation Grant 002.

References

  1. Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007;369:1641-57. https://doi.org/10.1016/S0140-6736(07)60751-X
  2. Oliveira SB, Monteiro IM. Diagnosis and management of inflammatory bowel disease in children. BMJ 2017;357:j2083.
  3. Kapoor A, Bhatia V, Sibal A. Pediatric inflammatory bowel disease. Indian Pediatr 2016;53:993-1002. https://doi.org/10.1007/s13312-016-0975-0
  4. Bishop J, Lemberg DA, Day A. Managing inflammatory bowel disease in adolescent patients. Adolesc Health Med Ther 2014;5:1-13.
  5. Peloquin JM, Goel G, Villablanca EJ, Xavier RJ. Mechanisms of pediatric inflammatory bowel disease. Annu Rev Immunol 2016;34:31-64. https://doi.org/10.1146/annurev-immunol-032414-112151
  6. Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn's disease. Lancet 2017;389:1741-55. https://doi.org/10.1016/S0140-6736(16)31711-1
  7. Amaro F, Chiarelli F. Growth and puberty in children with inflammatory bowel diseases. Biomedicines 2020;8:458.
  8. Burgess D, McGrath KH, Watson C, Collins T, Brown S, Marks K, et al. Exclusive enteral nutrition: an optimal care pathway for use in children with active luminal Crohn's disease. J Paediatr Child Health 2022;58:572-8. https://doi.org/10.1111/jpc.15911
  9. van Rheenen PF, Aloi M, Assa A, Bronsky J, Escher JC, Fagerberg UL, et al. The medical management of paediatric Crohn's disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis 2021;15:171-94. https://doi.org/10.1093/ecco-jcc/jjaa161
  10. Grover Z, Muir R, Lewindon P. Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease. J Gastroenterol 2014;49:638-45. https://doi.org/10.1007/s00535-013-0815-0
  11. Turner D, Ricciuto A, Lewis A, D'Amico F, Dhaliwal J, Griffiths AM, et al.; International Organization for the Study of IBD. STRIDE-II: an update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology 2021;160:1570-83. https://doi.org/10.1053/j.gastro.2020.12.031
  12. Grover Z, Burgess C, Muir R, Reilly C, Lewindon PJ. Early mucosal healing with exclusive enteral nutrition is associated with improved outcomes in newly diagnosed children with luminal Crohn's disease. J Crohns Colitis 2016;10:1159-64. https://doi.org/10.1093/ecco-jcc/jjw075
  13. Nicholas DB, Otley A, Smith C, Avolio J, Munk M, Griffiths AM. Challenges and strategies of children and adolescents with inflammatory bowel disease: a qualitative examination. Health Qual Life Outcomes 2007;5:28.
  14. Svolos V, Gerasimidis K, Buchanan E, Curtis L, Garrick V, Hay J, et al. Dietary treatment of Crohn's disease: perceptions of families with children treated by exclusive enteral nutrition, a questionnaire survey. BMC Gastroenterol 2017;17:14.
  15. Zallot C, Quilliot D, Chevaux JB, Peyrin-Biroulet C, Gueant-Rodriguez RM, Freling E, et al. Dietary beliefs and behavior among inflammatory bowel disease patients. Inflamm Bowel Dis 2013;19:66-72. https://doi.org/10.1002/ibd.22965
  16. Palant A, Koschack J, Rassmann S, Lucius-Hoene G, Karaus M, Himmel W. "And then you start to loose it because you think about Nutella": the significance of food for people with inflammatory bowel disease - a qualitative study. BMC Gastroenterol 2015;15:93.
  17. Chuong KH, Haw J, Stintzi A, Mack DR, O'Doherty KC. Dietary strategies and food practices of pediatric patients, and their parents, living with inflammatory bowel disease: a qualitative interview study. Int J Qual Stud Health Well-being 2019;14:1648945.
  18. Czuber-Dochan W, Morgan M, Hughes LD, Lomer MCE, Lindsay JO, Whelan K. Perceptions and psychosocial impact of food, nutrition, eating and drinking in people with inflammatory bowel disease: a qualitative investigation of food-related quality of life. J Hum Nutr Diet 2020;33:115-27. https://doi.org/10.1111/jhn.12668
  19. Joachim G. The relationship between habits of food consumption and reported reactions to food in people with inflammatory bowel disease--testing the limits. Nutr Health 1999;13:69-83. https://doi.org/10.1177/026010609901300203
  20. Cohen AB, Lee D, Long MD, Kappelman MD, Martin CF, Sandler RS, et al. Dietary patterns and self-reported associations of diet with symptoms of inflammatory bowel disease. Dig Dis Sci 2013;58:1322-8. https://doi.org/10.1007/s10620-012-2373-3
  21. Hou JK, Lee D, Lewis J. Diet and inflammatory bowel disease: review of patient-targeted recommendations. Clin Gastroenterol Hepatol 2014;12:1592-600. https://doi.org/10.1016/j.cgh.2013.09.063
  22. Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, de Ridder L, et al. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014;58:795-806. https://doi.org/10.1097/MPG.0000000000000239
  23. Ishige T. Growth failure in pediatric onset inflammatory bowel disease: mechanisms, epidemiology, and management. Transl Pediatr 2019;8:16-22.  https://doi.org/10.21037/tp.2018.12.04
  24. Day AS, Whitten KE, Lemberg DA, Clarkson C, Vitug-Sales M, Jackson R, et al. Exclusive enteral feeding as primary therapy for Crohn's disease in Australian children and adolescents: a feasible and effective approach. J Gastroenterol Hepatol 2006;21:1609-14. https://doi.org/10.1111/j.1440-1746.2006.04294.x
  25. Brown SC, Whelan K, Frampton C, Wall CL, Gearry RB, Day AS. Food-related quality of life in children and adolescents with Crohn's disease. Inflamm Bowel Dis 2022;28:1838-43. https://doi.org/10.1093/ibd/izac010
  26. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nurs Plus Open 2016;2:8-14. https://doi.org/10.1016/j.npls.2016.01.001
  27. Engstrom I, Lindquist BL. Inflammatory bowel disease in children and adolescents: a somatic and psychiatric investigation. Acta Paediatr Scand 1991;80:640-7. https://doi.org/10.1111/j.1651-2227.1991.tb11923.x
  28. Rabbett H, Elbadri A, Thwaites R, Northover H, Dady I, Firth D, et al. Quality of life in children with Crohn's disease. J Pediatr Gastroenterol Nutr 1996;23:528-33. https://doi.org/10.1097/00005176-199612000-00003
  29. Moody G, Eaden JA, Mayberry JF. Social implications of childhood Crohn's disease. J Pediatr Gastroenterol Nutr 1999;28:S43-5.  https://doi.org/10.1097/00005176-199904001-00008