Global Variation in Use of Enteral Nutrition for Pediatric Crohn Disease

Objectives: Exclusive enteral nutrition (EEN) is an effective induction treatment for pediatric Crohn disease. Given the center-based variation in use and diversity in practice we constructed a survey aimed at sharing experience and strategies in administering EEN, stimulating further research, and optimizing therapy. Methods: This survey was constructed after consultation with experts and designed to address key knowledge gaps. The survey was disseminated through the Paediatric IBD Porto Group of ESPGHAN, Canadian Children IBD Network, selective experts, and was sent twice through the PEDGI-BB. Data were collected into REDCap and analyzed using descriptive statistics. Results: In total, 146 participants from 26 countries completed the survey. Sixty-five percent of participants were general, non-IBD-focused pediatric gastroenterologists, 21% were IBD-focused, and 10% were dietitians. The most common indications (∼90% use) were for ileocecal and ileocolonic disease (Paris L1 and L3). The most common duration was 8 weeks and 66% preferred oral to nasogastric administration. Most (63%) did not allow any additional intake and 69% instructed patients to continue partial EN after completing treatment. Dietitians were identified as essential to EEN success while the primary challenges of EEN programs were adherence and lack of support. Regional and professional practice differences were observed in EEN indication, age, exclusivity, program structure/support, and cost coverage. Conclusions: We found significant variation in practice and use of EEN with several regional and professional differences. Global variation offers opportunities for research and improving care. This survey establishes a framework and provides resources for collaboration and information sharing. Address correspondence and reprint requests to Eytan Wine, MD, PhD, FRCPC, Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, Room 4-577, 11405 87th Avenue, Edmonton AB, T6G 1C9, Canada (e-mail: wine@ualberta.ca). Received 15 December, 2017 Accepted 4 February, 2018 Funding source: N/A. The Authors declare no relevant conflicts of interest. Author contribution: ML performed data analysis, drafted the results, and wrote the first draft of the manuscript. JWW assisted with study design, helped draft the manuscript, and performed data analysis. VMNL coordinated data collection from Spain, preformed data analysis, and helped draft the manuscript. HQH assisted with study design and helped draft the manuscript. MWC assisted with study design and helped draft the manuscript. MC assisted with study design and helped draft the manuscript. PM assisted with study design, constructed the survey database, and helped draft the manuscript. ASD provided key data for the study and helped draft the manuscript. SH provided key data for the study and helped draft the manuscript. RSB assisted with the study concept and design and helped draft the manuscript. AL assisted with the study concept and design and helped draft the manuscript. EW initiated the study, constructed the survey, invited participants, supervised the project, performed data analysis, and wrote the manuscript. All the authors approved the final version of the paper. Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org). © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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