Efektivitas Pemberian Nutrisi Enteral Eksklusif terhadap Induksi Remisi Penyakit Crohn

Muzal Kadim, Jennie Dianita Sutantio

Sari


Latar belakang. Pemberian nutrisi enteral eksklusif (NEE) direkomendasikan sebagai terapi lini pertama induksi remisi penyakit Chron pada anak. Namun, terdapat perbedaan aplikasi terapi di berbagai negara, termasuk Indonesia.
Tujuan. Mengetahui efektivitas terapi NEE dibanding kortikosteroid untuk induksi remisi penyakit Crohn pada anak.
Metode. Pencarian artikel dilakukan melalui basis data PubMed dan Cochrane dengan kata kunci yang sesuai. Seleksi dilakukan sesuai kriteria inklusi dan eksklusi. Telaah kritis dilakukan dengan evaluasi validity, importance, dan applicability.
Hasil. Dua artikel berupa studi meta-analisis dan uji klinis acak terkontrol didapatkan dari hasil pencarian. Meta-analisis terhadap 3 studi menunjukkan tidak ada perbedaan bermakna kedua terapi terhadap induksi remisi (OR 1,31, IK 95% 0,68-2,53). Uji klinis acak terkontrol juga menunjukkan hal yang serupa (NEE 100% vs kortikosteroid 83%), tetapi didapatkan penyembuhan mukosa yang bermakna pada kelompok NEE (89%) dibanding kortikosteroid (17%).
Kesimpulan. Pemberian NEE sama efektif dengan kortikosteroid untuk induksi remisi penyakit Crohn pada anak. Namun, pemberian NEE perlu direkomendasikan karena efek penyembuhan mukosa yang lebih baik.


Teks Lengkap:

PDF

Referensi


Ruemmele FM, Veres G, Kolho KL, dkk. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Chrons Colitis 2014;8:1179-207.

Grossman AB. Pediatric Crohn’s disease. 2018 Oktober 23 [diakses tanggal 15 Januari 2019]. Didapat dari: https://emedicine.medscape.com/article/928288-overview#a1.

Ong C, Aw MM, Liwanag MJ, dkk. Rapid rise in the incidence and clinical characteristics of pediatric inflammatory bowel disease in a South-East Asian cohort in Singapore:1994-2015. J Dig Dis 2018;19:395-403.

Pigneur B, Seksik P, Viola S, dkk. Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis 2010;16:953–61.

Connors J, Basseri S, Grant A, dkk. Exclusive enteral nutrition therapy in paediatric Crohn’s disease results in long-term avoidance of corticosteroids: results of a propensity-score matched cohort analysis. J Crohns Colitis 2017;11:1063-70.

Critch J, Day AS, Otley A, dkk. Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn disease. JPGN 2012;54:298-305.

Swaminath A, Feathers A, Ananthakrishnan AN, dkk. Systematic review with meta-analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn’s disease. Aliment Pharmacol Ther 2017;46:645-56.

Pigneur B, Lepage P, Mondot S, dkk. Mucosal healing and bacterial composition in response to enteral nutrition versus steroid based induction therapy – a randomized prospective clinical trial in children with Crohn’s disease. Diakses pada 15 Jan 2019. Didapat dari: https://academic.oup.com/ecco-jcc/

advance-article-abstract/doi/10.1093/ecco-jcc/jjy207/5240301?

redirectedFrom=fulltext.

Borrelli O, Cordischi L, Cirulli M, dkk. Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn’s disease: a randomized controlled open-label trial. Clin Gastroenterol Hepatol 2006;4:744-53.

Lambert B, Lemberg DA, Leach ST, dkk. Longer-term outcomes of nutritional management of Crohn’s disease in children. Dig Dis Sci 2012;57:2171-7.

Levine A, Turner D, Gik TP, dkk. Comparison of outcomes parameters for induction of remission in new onset pediatric Crohn’s disease: evaluation of the porto IBD group “growth relapse and outcomes with therapy” (GROWTH CD) study. Inflamm Bowel Dis 2014;20:278-85.

Pigneur B, Lepage P, Mondot S, dkk. Mucosal healing and bacterial

composition in response to enteral nutrition versus steroid based induction therapy – a randomized prospective clinical trial in children with Crohn’s disease. Des 2018 [diakses pada 15 Januari 2019]. Didapat dari: https://academic.oup.com/ecco-jcc/advancearticle-

abstract/doi/10.1093/ecco-jcc/jjy207/5240301.

Bousvaros A. Overview of the management of Crohn disease in children and adolescents. 2018 Okt [diakses pada 15 Januari 2019]. Didapat dari: https://www.uptodate.com/contents/

overview-of-the-management-of-crohn-disease-in-children-andadolescents?source=history_widget.

Zachos M, Tondeur M, Griffiths AM. Enteral nutritional therapy for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2007;1:CD000542.

Dziechciarz P1, Horvath A, Shamir R, dkk. Meta-analysis: enteral nutrition in active Crohn’s disease in children. Aliment Pharmacol Ther 2007;26:795-806.




DOI: http://dx.doi.org/10.14238/sp21.1.2019.57-65

Refbacks

  • Saat ini tidak ada refbacks.


##submission.copyrightStatement##

##submission.license.cc.by-nc-sa4.footer##

Informasi Editorial:
Badan Penerbit Ikatan Dokter Anak Indonesia
Jl. Salemba I No 5, Jakarta 10430, Indonesia
Phone/Fax: +62-21-3912577
Email: editorial [at] saripediatri.org

Lisensi Creative Commons
Sari Pediatri diterbitkan oleh Badan Penerbit Ikatan Dokter Anak Indonesia
Ciptaan disebarluaskan di bawah Lisensi Creative Commons Atribusi-NonKomersial-BerbagiSerupa 4.0 Internasional.