Abstract

Background: Active Crohn’s disease can be treated using ‘liquid diet therapy’ (LDT) with temporary cessation of normal food. However non-adherence may limit success necessitating corticosteroid therapy. It is now believed that a whole-protein ‘polymeric formula’ (PF) is as effective as the previously used amino acid based ‘elemental formula’ (EF). PF is said to be much more palatable, and this has been seen as an important advance significantly improving adherence to LDT.

Aim: To compare adherence to LDT using PF versus EF. Methods: A cohort of children presenting with active disease and treated with EF (n=53) were compared with a subsequent cohort given PF (n=45). Success in completing a 6 week course of LDT was compared. The need for nasogastric tube administration of formula in the two groups was compared. The use of LDT for relapses occurring in the first year after presentation was compared.

Results: There was no difference in remission rate with EF (64%; 95%C.I. 51, 77) versus PF (51%; 95%C.I. 37, 66) (p>0.15). In total 72% (95%C.I. 60, 84) given EF completed the initial course of LDT compared with 58% (95%C.I. 44, 72) given PF (p=0.15). Of those who failed to complete the first course of LDT only 13% on EF and 16% on PF gave up by choice (non-adherence), the remainder stopping due to treatment failure. Nasogastric administration was required more often with EF (55%, 95%C.I. 42, 68) compared to PF (31%, 95%C.I. 17, 45) (p=0.02). Even among those treated successfully at first presentation, LDT was used for just 28% of relapses in the EF group (95%C.I. 12, 44) and 39% of relapses in the PF group (95%C.I. 19, 59) (p>0.2) over the next year.

Conclusion: PF had no detectable impact on adherence to LDT. However, its introduction was associated with a significant reduction in the need for nasogastric tube administration of the feed.