A153 MEASURING QUALITY OF LIFE AND DISEASE ACTIVITY IN PEDIATRIC PATIENTS RECEIVING INDUCTION THERAPY OF EXCLUSIVE ENTERAL NUTRITION OR CORTICOSTEROIDS FOR ACTIVE INFLAMMATORY BOWEL DISEASE
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Abstract
Background
Inflammatory bowel disease (IBD) is a chronic illness that can affect a child’s physical, social and psychological well-being. Studies have shown that active IBD is associated with lower quality of life (QOL) scores in children. Exclusive enteral nutrition (EEN) and corticosteroids (CS) are effective treatment options for induction of remission in pediatric Crohn’s disease (CD), while CS is effective for ulcerative colitis (UC). EEN, however, is often poorly utilized due to perceived increased treatment burden. Two studies have shown that QOL in children receiving EEN is significantly better at the end of therapy compared to baseline. However, no studies have assessed the effects of EEN therapy on QOL longitudinally during treatment, or against other IBD treatment options.
Aims
To determine if there is a difference in longitudinal QOL scores in pediatric CD and UC patients receiving an 8-week course of EEN versus CS therapy.
Methods
This prospective cohort study involved patients 5–18 years old with IBD, followed up at McMaster Children’s Hospital (Hamilton, Ontario). Patients were included if they received EEN (Peptamen® 1.5) or CS therapy for induction of remission of moderate to severe CD or UC. All patients received 8 weeks of treatment. QOL was assessed using the KIDSCREEN-10 index. Clinical outcomes were assessed using the Pediatric UC Activity Index (PUCAI), or the modified Pediatric CD Activity Index (PCDAI). QOL and disease activity indices were assessed weekly during induction therapy, and 4 weeks after completion of therapy. Disease activity markers (albumin, CRP, fecal calprotectin) were also assessed during the course of induction therapy.
Results
31 patients were enrolled. 17 patients received induction therapy with EEN and 14 with CS. In CD patients, as PCDAI decreased, QOL significantly increased (R=-0.41; p<0.001). Similar significant trends were seen in UC patients (R=-0.345; p=0.042). There was a small, but significant difference in QOL between the children on CS (higher QOL) and those on EEN of 2.24 points using the KIDSCREEN 10 index (95% CI 0.34–4.15; p=0.021). For the children on EEN or CS, an increase in QOL significantly correlated with a decrease in CRP levels (R=-0.271; p=0.041), however, such a correlation was not seen with albumin or fecal calprotectin.
Conclusions
Pediatric IBD patients receiving treatment for induction of remission experience an increase in quality of life as disease activity and CRP decreased. While there is a significantly higher QOL in patients on CS compared to EEN, the difference is small, and physicians and families should still consider the benefits of EEN therapy and its superior side-effect profile when choosing therapy for induction of remission.
