Microbiota signatures and mucosal healing in the use of enteral nutrition therapy versus corticosteroids for the treatment of children with Crohn's disease: A systematic review and meta-analysis.

Corticosteroids (CS) and exclusive and partial enteral nutrition (EEN & PEN) are effective therapies in paediatric Crohn's disease (CD). This systematic review of randomised controlled trials (RCTs) and cohort studies analyses the impact of EEN/PEN versus CS on intestinal microbiota, mucosal healing as well as other clinically important outcomes, including clinical remission, relapse, adherence, adverse events, and health-related quality of life (HRQL) in paediatric CD. Three RCTs (n=76) and 16 cohort studies (n=1104) compared EEN versus CS. With limited available data (one RCT), the effect on intestinal microbiome indicated a trend toward EEN regarding Shannon diversity. Based on two RCTs, EEN achieved higher mucosal healing than CS (Risk Ratio [RR] 2.36, 95% confidence intervals (CI) 1.22 to 4.57, low certainty). Compared to CS, patients on EEN were less likely to experience adverse events based on two RCTs (RR 0.32, 95% CI 0.13 to 0.80, low certainty). For HRQL, there was a trend in favour of CS based on data from two published abstracts of cohort studies. Based on 13 cohort studies, EEN achieved higher clinical remission than CS (RR 1.18, 95% CI 1.02 to 1.38, very low certainty). Studies also reported no important differences in relapse and adherence. Compared to CS, EEN may improve mucosal healing with fewer adverse events based on RCT data. While limited data indicates the need for further trials, this is the first systematic review to comprehensively summarise the data on intestinal microbiome, mucosal healing and HRQOL when comparing enteral nutrition and CS in paediatric CD.