Nutritional Therapies

Existing data supports the use of primary nutritional therapy in pediatric CD and suggests equal efficacy to corti-costeroids but with better growth and development and fewer side effects (Heuschkel et al, 2000).We occasionally use nutritional therapy in the form of 1 Cal/mL liquid formulas in children as the sole therapy for acute flares but more commonly in a supplemental role with other primary therapies. The volume of formula needed is often far greater than patients will take orally, thus necessitating nighttime NG feeds. Many patients cannot accept this. For maintenance of remission, given the high rate of relapse after sole primary nutritional therapy, support has been shown for the continuation of enteral nutrition as a nocturnal supplement to an otherwise normal daytime diet in children (Wilschanski et al, 1996).The further question of whether the enteral liquid formula should be elemental or polymeric is unclear, but currently there is no evidence to support that one is more efficacious than the other (Rigaud

Table 67-2.Therapy for Crohn's Disease

Mild to moderate active CD

5-ASA drug-oral and/or rectal for active disease Antibiotics—for distal disease and fistulas Corticosteroids (budesonide) for active disease

6-MP/AZA for corticosteroid resistance or dependence

Methotrexate for 6-MP/AZA resistance or intolerance (less commonly used) Anti-TNF-a antibody in corticosteroid resistant patients, in fistulizing disease, in place of corticosteroids; after and with immunomodulators Severe Crohn's disease Corticosteroids Anti-TNF-a antibody 6-MP/AZA

Elemental diet or TPN—provides nutritional support and may directly lead to decreased inflammation Maintenance therapy 5-ASA, 6-MP/AZA, MTX, Anti-TNF-a antibody in selected patients

5-ASA = aminosalicylic acid; AZA = azathioprine; CD = Crohn's disease; MP = mercaptopurine; MTX = methotrexate; TNF = tumor necrosis factor; TPN = total parenteral nutrition.

et al, 1991). In selected patients where there is an acute need for nutritional support, total parenteral nutrition (TPN) has a role and has been shown to enhance linear growth significantly (Keller and Wirth, 1992).Examples where we have used TPN include extensive small bowel disease, bowel obstruction or situations in which eliminating the fecal stream is desireable, such as fulminant colitis, fis-tulizing disease, or severe perianal disease.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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