Nutritional preparations: a treatment for Crohn's disease in children

Author: Luo Youyou, deputy chief physician of Children's Hospital affiliated to Zhejiang University School of Medicine

Reviewer: Chen Jie, Chief Physician, Children's Hospital Affiliated to Zhejiang University School of Medicine

Illustration: Miao Xueqin Che Yanfen

What is Crohn's disease?

Crohn's disease is a chronic inflammatory disease of the intestine. Most Crohn's disease lesions are located in the large intestine and small intestine. Severe children will have lesions in the entire digestive tract from the mouth, esophagus, stomach, duodenum, small intestine, large intestine, to the anus. Children with Crohn's disease may experience stomach pain, diarrhea, even bloody stools, and weight loss; some children will feel a mass in the abdomen or around the anus; some children will develop fistulas around the anus, accompanied by pain and pus; severe children will have fever, and blood test results will indicate changes such as decreased albumin, increased white blood cells, and increased C-reactive protein. Some children will also have extraintestinal manifestations, such as red eyes, rash, joint pain, abnormal liver function, etc. In the occurrence and development of Crohn's disease, the intestines may develop ulcers, stenosis, perforation, etc., and even require surgical treatment.

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How is Crohn's disease treated?

Drugs for the treatment of Crohn's disease include mesalazine, glucocorticoids, immunosuppressants, and biological agents. These drugs heal intestinal ulcers by fighting inflammation and regulating the immune function of children. It has been found that nutritional therapy can also relieve Crohn's disease and heal ulcers, playing a similar role to drug therapy. This method is called total enteral nutrition therapy.

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What is total enteral nutrition therapy?

Total enteral nutrition therapy means that nutrition is completely taken into the digestive tract through the mouth or through a feeding tube, without taking in ordinary food. Therefore, during total enteral nutrition therapy, children cannot eat any other food except enteral nutrition and water. It has been confirmed that total enteral nutrition is an effective method for treating mild to moderate Crohn's disease in children. This method has been used as the first-line treatment for mild to moderate Crohn's disease in children by multiple guidelines.

Nutritional therapy itself can improve the nutritional status of patients, increase weight, and promote the height growth of children. And total enteral nutrition therapy can have a similar effect on Crohn's disease as drug therapy. Therefore, this treatment method can kill two birds with one stone for children with Crohn's disease.

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How to perform total enteral nutrition therapy?

1. The course of total enteral nutrition: 6 to 12 weeks.

2. Choice of enteral nutrition preparations: enteral nutrition preparations with whole protein formula and high energy density are preferred. If the child is allergic to milk protein, enteral nutrition preparations with amino acid formula or deep hydrolysis formula can be selected. If the child is lactose intolerant, enteral nutrition preparations with lactose-free formula can be selected.

3. Daily intake: The intake of total enteral nutrition is determined by the doctor, who will give the appropriate intake based on the child's height, weight and age, and adjust it according to the child's symptoms and weight gain.

4. Methods of giving full enteral nutrition: Oral drinking of enteral nutrition preparations is the first choice. If the child cannot complete the amount recommended by the doctor, a feeding tube can be inserted through the nose to input the enteral nutrition preparation into the digestive tract through the feeding tube.

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5. Points to note during total enteral nutrition therapy

During treatment, no food other than enteral nutrition preparations and water can be taken.

(2) The amount of enteral nutrition should be sufficient. If the child cannot complete the amount recommended by the doctor, it is necessary to communicate with the doctor in time to adjust the treatment plan. Otherwise, the condition may worsen.

(3) After about 2 weeks of total enteral nutrition treatment, the child must go to the doctor's clinic for a follow-up visit to assess the condition and nutritional status of the child in order to facilitate continued treatment in the later stages.

(4) Before starting full enteral nutrition treatment, you can gradually transition from partial enteral nutrition to full enteral nutrition under the guidance of a doctor, based on the child's basic nutritional status. This period is generally 3 to 7 days. After completing 6 to 12 weeks of full enteral nutrition, you can gradually add clear liquids, residue-free semi-liquids, semi-liquids, and ordinary soft foods until you reach a normal diet. At the same time, gradually reduce the amount of enteral nutrition preparations under the doctor's advice. The specific time and food ratio need to be determined by the doctor based on the different conditions of each child.

Children with Crohn's disease benefit greatly from enteral nutrition therapy. Nutritional preparations are effective and low-risk treatments for children with Crohn's disease. Unfortunately, however, nutritional therapy cannot be used as a maintenance treatment for children with Crohn's disease. After successful enteral nutrition therapy, some oral immunosuppressants are needed for maintenance treatment.