Why we use EEN in kids and why it works

[my little penguin]

Seen numerous posts about the "bad things in formula"
Sugar fat etc( which are also part of tpn at the basic level btw)

This is a study on why EEN might work

RESULTS:
Changes in CD patient microbial community structure before and during EEN were variable. However, functional profiling of CD patient microbiota before and during EEN treatment revealed a significant increase in metabolic functions related to biodegradation and metabolism of xenobiotics, such as benzoate (p<0.05). BiomeNet uncovered changes during weeks 4 and 8 of treatment consistent with large-scale changes in metabolic interactions at the community level. We observed associated changes in community diversity: a decrease and then increase in diversity over the course of EEN treatment. Metabolic potential generally increased at the same time as diversity decreased. This could be due to the metabolic repertoire of those species that were present (as inferred from enzyme encoding gene sequences). Bayesian modeling of metabolic structures via BiomeNet revealed that the therapeutic effect of EEN might be predicted by monitoring the change in community level metabolic structures over the course of treatment.
Induction of clinical remission by EEN was characterized by a distinct cycle of change in community level metabolic structure, and the microbiome of the one patient that experienced several severe flare-ups did not complete this cycle of change. This finding suggests that community metabolic function could be monitored for the purpose of determining if the duration of EEN was sufficient to maintain a flare free state. Alternatively, patients who complete the cycle quickly might discontinue EEN early.


CONCLUSION:
The microbiome of CD patients is functionally altered during EEN treatment. Metabolic potential for xenobiotic biodegradation and metabolism increases during treatment, but then, after 12 weeks, it returns to a state very similar to pre-treatment and controls.

From
https://uegw.congress-online.com/guest/IDbdf617e25c118e/AbstractView?ABSID=12614

So while high sugar from regular food does not help the gut bacteria etc

Formula is a whole other catergory

Things to consider

 

[my little penguin]

For those looking to cycle EEN

https://clinicaltrials.gov/ct2/show/NCT02201693

Ds is doing similar two weeks EEN then off
But remains on other meds as well

 

[Pilgrim]

Thanks for posting this. I wonder how this translates to supplementary formula.

 

[my little penguin]

Not sure how partial en translates but I assume affects the gut in a beneficial way
I know from probiotics that you do a double dose for a month then enough good bacteria are populated that a single dise a day is enough to keep things going

I assume the same way with EEN transitioned to en
But not sure

We may try two weeks on EEN and six weeks of with just supplement
Will see still looking for the magic

 

[Optimistic]

My son really never has a day with less than 4 cans of EN. Some days he has 6+. I do wonder what role the EN plays. Have not found any studies.

 

[my little penguin]

Optimistic if he is drinking 6+ a day how many total calories from food is he getting ?
Ds drinks 8 when he is on complete EEN

 

[Optimistic]

I'll look at food diary he keeps prior to dietician meetings to be sure but he takes in a ridiculously high number of calories and burns a lot too.

Shakes are always incremental to meals, never in place of. We don't let him have them until he eats. He has a huge breakfast and dinner at home and lunch too on weekends. The only exception is lunch at school can be limited bc of SCD so he may have a shake or two with whatever SCD offerings they have. The other shakes are after school, after a practice, before bed etc.

I think the reco was 12 when he was on full EEN. He is a big kid but the GI(s) had seen some early work (Israel? Belgium? Forgot) that showed good success with more quantity so we gave it a try.

 

[my little penguin]

Objectives: Exclusive enteral nutrition (EEN) is commonly used to treat pediatric Crohn’s disease (CD). Meta-analysis of pediatric studies that have compared the effect of EEN with other treatments have shown that EEN induces remission in up to 80–85% of patients. We aimed to gain a comprehensive understanding of the effect of EEN on the microbiota of CD patients.
Methods: We used 16S rRNA gene and whole-genome high throughout sequencing to determine changes in the fecal microbiota of five CD children, before, during, and after EEN therapy and compared this with five healthy controls.
Results: The microbial diversity observed in CD patients tended to be lower than that in controls (CD: 2.25±0.24, controls: 2.75±0.14, P=0.11). In all CD patients, dysbiosis was observed prior to therapy. EEN therapy had a positive effect in all patients, with 80% going into remission. In some patients, the positive effect diminished following the conclusion of EEN therapy. Significantly, the number of operational taxonomic units (OTU) decreased dramatically upon starting EEN and this corresponded with CD remission. Recurrence of CD corresponded with an increase in OTUs. Six families within the Firmicutes were found to correlate with disease activity during and following EEN therapy, a finding that was confirmed by whole-genome high throughput sequencing.
Conclusions: Our results demonstrate that EEN leads to common and patient-specific alterations in the microbiota of CD patients, a number of which correlate with disease activity.

From
http://www.nature.com/ctg/journal/v6/n1/full/ctg201421a.html

 

[Tesscorm]

I know from probiotics that you do a double dose for a month then enough good bacteria are populated that a single dise a day is enough to keep things going

I assume the same way with EEN transitioned to en

This seems to describe S's experience with EEN and then supplemental. EEN took S to clinical remission (no MREs to compare but CRP went from 135 to 6 and ESR from 63 to 9). When he moved to partial (1/2 the amount of EEN), both CRP and ESR moved to 20s. Subsequent MREs (2 or 3??), over the next two years, showed 20-30 cm of inflammation but, although he was only on partial EN, this never changed (in the sense that it didn't worsen). When we transferred to his adult GI, his thought was that, while partial EN wasn't able to eliminate all inflammation, it had kept inflammation controlled.

All the 'oldies' know I'm a big believer in EEN and EN and S still drinks one to two shakes per day (most days). I don't know how it works but it may be that it maintains a solid nutritional status that allows your body to work efficiently?? Or, perhaps, by supplementing, you end up eating less food which allows the bowels to work a little less?? (ie bowel rest is one of the healing benefits of EEN.) The ped GI had explained to me that EEN feeds the 'good bacteria' but not the 'bad' - perhaps, partial EN gives the 'good bacteria' just a little bit more fighting power??? IDK if it deserves all the credit but it seems to have kept S healthy. (Bonus is that he's always been a picky eater and with the one/two shakes, I know he's getting some nutrition!)

I once copied a link to a study that showed partial EN increased remicade's success rate by a good margin. I'm sure I posted it in the kids' research section... I'll try to find it and post here...

 

[my little penguin]

http://nutricia.co.uk/e028/uploads/E028DietitiansGuide.pdf

 

[Tesscorm]

Link to article...

Effectiveness of concomitant enteral nutrition therapy and infliximab for maintenance treatment of Crohn's disease in adults.


http://www.crohnsforum.com/showthread.php?t=55580

 

[my little penguin]

http://gut.bmj.com/content/38/4/543.full.pdf

 

[my little penguin]

http://www.hindawi.com/journals/scientifica/2014/423817/

 

[Farmwife]

Grace still does EEN and EN. Hers is more out of necessity to keep her weight up.
At first it was to reach remission but she still need more in the way of meds.

 

[my little penguin]

http://www.espen.org/presfile/Lopes_2015.pdf

Good explanation of combo