EoE Dietary Pointers (Syllabus pg 83-94): Sally Schwartz, Valeria Cohran
- Even with SFED, elemental supplements helpful
- Drink elemental beverages from covered glass with straw (improves palatability)
- Cross-contamination –big issue
- Label reading critical
- Systemic Review of Dietary Treatments for Eosinophilic …
- Do We Still Need PPI-REE? | gutsandgrowth
- Predicting Response to Topical Steroids in Eosinophilic …
IBD EEN Pointers (Syllabus pg 95-102): Rebecca Pipkorn, Justine Turner
- Polymeric formulas –most palatable and least expensive. Oral EEN is used costly/not covered
- EEN particularly helpful with microperforation/flare-up presentation and with infections (eg. TB)
- EEN induces mucosal healing and improved symptoms
- Levin et al. Inflamm Bowel Dis. 2014;20:278-285.
- Johnson et al. Gut 2006;55:356-361.
- Sigall-Boneh et al. Inflamm Bowel Dis. 2014;20:1353-1360.
- Wilschanski et al. Gut 1996;38543–548.
- Critich et al. J Pediatr Gastroenterol Nutr. 2012;54: 298–305. NASPGHAN Guidelines
- Enteral therapy offers an alternative to steroids in patients with CD
- Has potential to improve growth and IBD symptoms
- Avoids the side effects of steroids
- Need further research:
- – Unclear of the mechanism
- – Unclear of the best protocol
- – No standard protocol for reintroduction of food
- Enteral Nutrition for Crohn’s Disease – gutsandgrowth
- Practical Advice on Enteral Nutrition | gutsandgrowth
- Top Lecture: Enteral Nutrition for Crohn’s Disease …
Cystic Fibrosis (Syllabus pg 34-50) Justine Turner
Case in point: 10 yo with CF and poor growth, hx/o DIOS, poor intake, and distention. Family had refused tube feedings previously.
Key point: Long-term survival is linked to nutritional status
- Zemel et al. J Pediatr. 2000; 137(3):374-380.
- Stallings et al. J Am Diet Assoc. 2008; 108(5):832-839.
- McPhail et al. J Pediatr. 2008; 153(6):752-757.
- Sharma et al. Thorax 2001; 56:746-750.
- Intervene early
- Breast milk (often with supplements) is optimal for infants
- Poor oral intake àcould need periactin and/or supplemental feeds
- Discussion re: pros/cons of Gtubes (pg 47 in syllabus)
- Psychology support
- – Normal growth and optimal nutritional status
- – Ages 0-2 year: Weight for length >50th percentile
- – Ages 2-20 year: BMI percentile at or above 50th percentile
- – BMI for males:23
- – BMI for females: 22
Nutritional assessment at every visit & review:
- – Weight, length/height, weight for length, BMI, head circumference in infants
- – Nutritional education & dietary counseling
- – Review PERT
- – Review need for micronutrient supplementation: fat soluble vitamins (A, D, E, K), Ca, Fe, Zn, Na (salt), essential fatty acids
PERT (Pancreatic enzyme replacement therapy):
- Infants 2000-4000 U lipase with 120 mL breast milk or formula– Mouth care for infants (and breast feeding mother)
- Children 500-2500 U lipase/kg per meal (≤10000 U/kg/day or ≤ 4000 U/g fat/day); half meal dose with snacks
- Ideally taken with meals and orally
- Microspheres preferred formulation
- Acid blockade (used to optimize enzyme activity)
- Gold standard to assess adequacy is 72h fecal fat collection
Cystic Fibrosis Related Diabetes
- Rare before 10 years of age
- Increases mortality risk 6-fold
- Weight loss and pulmonary decline begin 2-4 years prior to
- diagnosis of CFRD
- Progress in Cystic Fibrosis over 18 Years | gutsandgrowth
- “Origins of Cystic Fibrosis Lung Disease” | gutsandgrowth