AUTHOR=Tang Wenjuan , Hu Wenhui , Shi Peng , Ye Ziqing , Wu Jie , Zhang Ye , Wang Yuhuan , Huang Ying 

TITLE=The SES-CD Could Be a Predictor of Short- and Long-Term Mucosal Healing After Exclusive Enteral Nutrition in Pediatric Crohn’s Disease Patients

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.874425

DOI=10.3389/fped.2022.874425

ISSN=2296-2360

ABSTRACT=Aims: To explore the predictors of mucosal healing (MH) to exclusive enteral nutrition (EEN) in the short- and long-term in pediatric Crohn's disease (CD) patients. Methods: A retrospective analysis was performed for newly diagnosed active CD patients admitted from January 2017 to December 30, 2020 in our center and treated with EEN for inducing therapy with a minimum of 12 months of follow-up post EEN. According to the Simple Endoscopic Score for CD (SES-CD) at 1-year post-EEN, 17 patients with SES-CD<3 were classified into the sustained MH group (sMH), and 33 patients with SES-CD≥3 were classified into the sustained non-MH group (sNMH). Statistical methods were used to compare the differences between the 2 groups and explore the predictors of MH to EEN at EEN ending and 1-year post-EEN. Results: The SES-CD in the sMH group was lower than that in the sNMH group both at baseline and EEN ending (sMH vs. sNMH: 8.7 ± 1.2 vs. 16.2 ± 1.0 P <0.001 at baseline; 1.0(3.5) vs. 4.0(2.0) P<0.01 at EEN ending), The weighted Pediatric Crohn's Disease Activity Index, erythrocyte sedimentation rate in sMH group were lower than the sNMH group at baseline but no difference at EEN ending (both P<0.05). From baseline to 1-year post-EEN, compared with patients in the sNMH group, there were more patients with L1 in the sMH group at each time point (all P<0.001) and fewer patients with L3 in the sMH group at baseline and 1-year post-EEN. After EEN, fewer patients received infliximab and a longer time to infliximab exposure in the sMH group than in the sNMH group. Only SES-CD at baseline was negatively associated with MH at EEN ending (OR=1.40 95% CI=1.12-1.67, P=0.00) and 1-year post-EEN (OR=1.33, 95% CI=1.12-1.58, P=0.001), the cut off value was 11.5. Conclusion: SES-CD could predict MH to EEN both short- and long-term. Patients with SES-CD<11.5 have a high probability of reaching MH by EEN-inducing therapy and maintaining sustained MH at 1-year post-EEN. Patients with an SES-CD greater than 11.5 at baseline should be treated more aggressively with biologics.