Dietary treatment of active Crohn's diseaseBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7097.1827a (Published 21 June 1997) Cite this as: BMJ 1997;314:1827
Dietary treatment is best for children
- J A Walker-Smith, Professor of paediatric gastroenterologya
- a Royal Free Hospital, London NW3 2QG
- b Gastroenterology Research Unit, Addenbrooke's Hospital, Cambridge CB2 2QQ
- c Department of Gastroenterology, County Hospital, Lincoln LN2 5QY
Editor—Nick Wight and Brian B Scott conclude that dietary treatment of active Crohn's disease is poorly tolerated and no more effective than steroids.1 Their editorial is chiefly based on adults. In children with Crohn's disease the importance of growth must influence the effect of any treatment. Enteral feeding is particularly useful for children with growth failure.
For children the side effects of corticosteroid treatment, particularly moon face, striae, and slowing of growth (with long term use), are of great concern to the child and to parents. Enteral feeding is as effective as corticosteroids in inducing a clinical remission in childhood.2 Furthermore, mean height velocity was significantly greater in the enterally fed group. A group of children with Crohn's disease was randomly allocated to treatment with steroids (n=6), cyclosporin (n=6), and enteral nutrition (n=6).3 Mucosal histological findings and the percentage of lymphokine secretory cells (interleukin 2 and γ interferon) in mucosal tissue, before and after treatment, was observed. Enteral nutrition produced a significant improvement in all three variables; with steroids only interleukin 2 secretory cells were reduced in number.
A cohort study of seven children with Crohn's disease has …