Nutritional treatment in childhood Crohn's disease

Growth retardation and delay in sexual maturation are the major complications of child-onset Crohn's disease (CD). Nutritional assessment and monitoring should comprise: weight and height measurement with calculation of respective velocities (growth velocity should be >= 4-5 cm/year during the prepubertal period); pubertal staging; dietetic evaluation; laboratory analysis for mineral, vitamin and trace element deficiencies; bone age. At diagnosis, weight loss and growth delay are present in 80-90% and 1/3 of cases, respectively. In case of an acute flare-up in a CD child with normal nutritional status, nutritional therapy is limited to oral feeding, with a caloric intake at least equal to recommended dietary allowances for age and sex. A low-fiber diet is advised in case of small bowel stenosis. No diet has been shown as efficient in the long-term maintenance of remission. Exclusive enteral nutrition (EN)is an alternative to corticosteroids for the treatment of an acute flare-up of CD, especially in case of malnutrition. Prolonged nocturnal EN is of great interest for the treatment of growth retardation and delay of sexual maturation and in case of steroid-dependent or steroid-refractory CD. In case of steroid-dependent CD with no delay of growth and/or sexual maturation, immunomodulating agents are nowadays an alternative to long-term EN. Efficacy of polymeric solutions is identical to that of semi-elemental or elemental solutions. Parenteral nutrition is limited to an acute flare-up with resistance to medical treatment and/or EN, and contraindications to surgery; occlusion or fistula; short bowel syndrome. (c) 2005 Elsevier SAS. Tous droits reserves.