Abstract：
OBJECTIVE: To investigate the association between disease location and segmental mucosal healing (SMH) following exclusive enteral nutrition (EEN) in children with Crohn\'s disease (CD).
METHODS: Treatment-naive pediatric patients with endoscopically active CD treated with EEN alone as induction therapy were retrospectively enrolled from January 1, 2017 to June 30, 2022. The simple endoscopic score for CD (SES-CD) was employed to score disease activity in the upper gastrointestinal (GI) tract (esophagus, stomach, duodenum), rectum, left colon, transverse colon, right colon, and terminal ileum. While the Lewis score assessed that of the small bowel from the jejunum to the proximal ileum (except the terminal ileum). The variation in the total scores for each segment and SES-CD subscores for each ileocolonic segment from baseline to 1 year after EEN therapy and the segmental endoscopic outcomes and potential predictors associated with SMH for the segments scored by SES-CD were evaluated.
RESULTS: Overall, 82 children with CD were enrolled. Except for the upper GI segment, scores in other segments declined significantly from baseline to EEN completion (all P < 0.001). We analyzed 486 segments (79, 80, 81, 82, 82 and 82 from upper GI tract, terminal ileum, right colon, transverse colon, left colon, and rectum) and found that the segmental SES-CD at baseline (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.55-0.70, P < 0.001) and upper GI location (OR 0.25, 95% CI 0.11-0.55, P = 0.001) were associated with SMH at EEN completion.
CONCLUSIONS: Disease location of the upper GI segment in pediatric CD was associated with SMH following EEN therapy.
METHODS: Treatment-naive pediatric patients with endoscopically active CD treated with EEN alone as induction therapy were retrospectively enrolled from January 1, 2017 to June 30, 2022. The simple endoscopic score for CD (SES-CD) was employed to score disease activity in the upper gastrointestinal (GI) tract (esophagus, stomach, duodenum), rectum, left colon, transverse colon, right colon, and terminal ileum. While the Lewis score assessed that of the small bowel from the jejunum to the proximal ileum (except the terminal ileum). The variation in the total scores for each segment and SES-CD subscores for each ileocolonic segment from baseline to 1 year after EEN therapy and the segmental endoscopic outcomes and potential predictors associated with SMH for the segments scored by SES-CD were evaluated.
RESULTS: Overall, 82 children with CD were enrolled. Except for the upper GI segment, scores in other segments declined significantly from baseline to EEN completion (all P < 0.001). We analyzed 486 segments (79, 80, 81, 82, 82 and 82 from upper GI tract, terminal ileum, right colon, transverse colon, left colon, and rectum) and found that the segmental SES-CD at baseline (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.55-0.70, P < 0.001) and upper GI location (OR 0.25, 95% CI 0.11-0.55, P = 0.001) were associated with SMH at EEN completion.
CONCLUSIONS: Disease location of the upper GI segment in pediatric CD was associated with SMH following EEN therapy.
摘要：
目的：探讨克罗恩病(CD)患儿行单纯肠内营养(EEN)治疗后的局部黏膜愈合(SMH)与病变部位的关系。
方法：从2017年1月1日至2022年6月30日，回顾性纳入未经治疗的内镜活性CD患儿，仅使用EEN作为诱导治疗。CD的简单内镜评分（SES-CD）用于对上消化道（GI）道（食道，胃,十二指肠)，直肠,左结肠,横结肠,右结肠,和回肠末端。而Lewis评分评估了从空肠到近端回肠（回肠末端除外）的小肠。评价了从基线到EEN治疗后1年，每个节段的总分和每个回肠结肠节段的SES-CD子评分的变化，以及SES-CD评分的节段内镜结局和与SMH相关的潜在预测因子。
结果：总体而言，82名患有CD的儿童被录取。除了上消化道,其他部分的评分从基线到EEN完成显著下降(均P<0.001).我们分析了来自上消化道的486个节段（79、80、81、82、82和82，回肠末端,右结肠,横结肠,左结肠,和直肠），并发现基线时节段SES-CD（比值比[OR]0.62，95％置信区间[CI]0.55-0.70，P<0.001）和上GI位置（OR0.25，95％CI0.11-0.55，P=0.001）与EEN完成时的SMH相关。
结论：EEN治疗后，小儿CD上消化道段的病变位置与SMH相关。
方法：从2017年1月1日至2022年6月30日，回顾性纳入未经治疗的内镜活性CD患儿，仅使用EEN作为诱导治疗。CD的简单内镜评分（SES-CD）用于对上消化道（GI）道（食道，胃,十二指肠)，直肠,左结肠,横结肠,右结肠,和回肠末端。而Lewis评分评估了从空肠到近端回肠（回肠末端除外）的小肠。评价了从基线到EEN治疗后1年，每个节段的总分和每个回肠结肠节段的SES-CD子评分的变化，以及SES-CD评分的节段内镜结局和与SMH相关的潜在预测因子。
结果：总体而言，82名患有CD的儿童被录取。除了上消化道,其他部分的评分从基线到EEN完成显著下降(均P<0.001).我们分析了来自上消化道的486个节段（79、80、81、82、82和82，回肠末端,右结肠,横结肠,左结肠,和直肠），并发现基线时节段SES-CD（比值比[OR]0.62，95％置信区间[CI]0.55-0.70，P<0.001）和上GI位置（OR0.25，95％CI0.11-0.55，P=0.001）与EEN完成时的SMH相关。
结论：EEN治疗后，小儿CD上消化道段的病变位置与SMH相关。
