Mucosal healing and a fall in mucosal pro‐inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease

Abstract

Background: Although enteral nutrition is a recognized form of treatment for intestinal Crohn’s disease, there are persisting problems with feed palatability and only limited data as to its mode of action. Aim: To assess the effects of a specific oral polymeric diet (CT3211; Nestle, Vevey, Switzerland), which is rich in transforming growth factor β2, on the mucosal inflammatory process. Methods: Twenty‐nine consecutive children with active intestinal Crohn’s disease were treated with CT3211 as the sole source of nutrition for 8 weeks. Patients were assessed clinically, and endoscopically, whilst cytokine mRNA was measured in mucosal biopsies before and after treatment by quantitative reverse transcriptase polymerase chain reaction. Results: After 8 weeks 79% of children were in complete clinical remission. Macroscopic and histological healing in the terminal ileum and colon was associated with a decline in ileal and colonic interleukin‐1 β mRNA (pre‐treatment to post‐treatment ratio 0.008 and 0.06: P < 0.001, P = 0.006). In the ileum there was also a fall in interferon γ mRNA (ratio 0.15, P < 0.001) with a rise in transforming growth factor β 1 mRNA (ratio 10, P = 0.04), whilst in the colon interleukin‐8 mRNA fell with treatment (ratio 0.06, P < 0.05). Conclusions: The clinical response to oral polymeric diet CT3211 is associated with mucosal healing and a down regulation of mucosal pro‐inflammatory cytokine mRNA in both the terminal ileum and colon. In the ileum there was also an increase in transforming growth factor β 1 mRNA.