A semielemental diet (Pregomin) as primary therapy for inducing remission in children with active Crohn's disease

Aims. To compare the efficacy of nutritional therapy alone versus corticosteroids for the treatment of a group of 20 children (median age: 12.4 years; range: 7-17 years) with active Crohn's disease. Nutritional therapy consisted of an extensively hydrolysed formula (Pregomin, Milupa) given for 8 weeks. Methods. Systemic diseases, food allergy, malabsorption syndromes and infectious disorders had been excluded in all. The patients underwent ileo-colonoscopy with biopsy and were clinically assessed according to the common pediatric Crohn's disease activity index (PCDAI). Patients were randomly allocated to receive either corticosteroids and mesalamine (group A) or nutritional therapy (group B). Patients were blindly evaluated clinically every two weeks and also endoscopically (with biopsy) at the end of the treatment. Results. At the end of the trial both treatments had been effective in reducing PCDAI (p < 0.01), endoscopic score (p < 0.01) and histological score (A: p < 0.05; B: p < 0.01); however, the nutritional group exhibited significantly lower post-trial scores than the corticosteroid group (p < 0.01). At 4 weeks after starting treatment PCDAI was significantly lower only in the nutritional group (p < 0.01). Clinical remission, defined as PCDAI < 10, was achieved in 9 (90%) patients in the nutritional group but only in 5 (50%) on corticosteroids (p < 0.01). Mean time elapsed to achieve remission was significantly shorter in the nutritional group than in the corticosteroid group (p < 0.05). Finally, nutritional therapy was more effective than corticosteroids in improving nutritional parameters such as serum ferritin, albumin and haemoglobin. Conclusion. A short course of an extensively hydrolysed formula given as sole therapy is more effective than corticosteroids in inducing clinical and inflammatory remission in children with active Crohn's disease. Nutritional treatment can be used as a first-line therapeutic approach in childhood with this condition.