Nutrition in paediatric Crohn’s disease

Abstract

Inflammatory bowel disease (IBD) such as Crohn’s disease (CD) results from the interaction between an individual’s immune response and precipitant environmental factors, which generate an anomalous chronic inflammatory response in those who are genetically predisposed. Protein-energy malnutrition (PEM) is a frequent consequence of CD. Macrophage products such as Tumour Necrosis Factor-α (TNF-α) and interleukins 1 and 6 may be the central molecules that link the inflammatory process to derangements of homeostasis. CD is associated with frequent nutritional deficiencies, the pattern and severity of which depends on the extent, duration and activity of the inflammation. Nutritional support is especially important in childhood CD as an alternative to pharmacological treatment, especially steroids. Current treatment regimens limit the use of corticosteroids, by using immunomodulatory drugs, recommend the use of enteral nutrition, and, if necessary, consider surgery for intestinal complications of localised CD. Biologic agents with the potential for mucosal healing hold promise of growth enhancement even among children whose growth remained compromised with previously available therapies. For all treatment modalities, there is a window of opportunity to achieve normal growth before puberty is too advanced.

Keywords: Crohn’s disease; linear growth; Tumour Necrosis Factor-α; nutritional support; enteral feeding; immunomodulation,