P-073: Exclusive enteral nutrition in the treatment of children with Crohn’s disease in the Netherlands: a questionnaire survey amongst dietitians

s of the 3rd International Symposium on Pediatric Inflammatory Bowel Disease S421 by body weight ( 40kg, 160/80mg; <40kg, 80/40mg). At wk 4, patients were randomized to double-blind higher-dose (HD) ADA ( 40kg, 40mg every other week [EOW]; <40kg, 20mg EOW) or lower-dose (LD) ADA ( 40kg, 20mg EOW; <40kg, 10mg EOW) to wk 52. Patients could escalate to blinded weekly therapy for flare or non-response, followed by OL HD ADA weekly for continued flare or non-response. Change from BL in height velocity z-score was measured at wk 26 and wk 52 in patients with and without growth delay at BL. Subgroup analyses by BL corticosteroid use, disease severity based on median BL PCDAI of study, and prior infliximab (IFX) use were performed. Results: Statistically significant improvement in growth was observed at wk 26 and wk 52 with ADA therapy in patients with growth delay (median height velocity z-score at BL 2.9; median change from BL: wk 26 = 2.4; wk 52 = 3.3, p < 0.001), but not in patients with normal growth. No significant differences between LD and HD ADA were observed. Growth improvement trended to be larger in patients with BL corticosteroid use, severe CD, and in IFX-naive patients. Conclusion: ADA treatment significantly improved growth in children with moderately to severely active CD and growth delay. P-073 Exclusive enteral nutrition in the treatment of children with Crohn’s disease in the Netherlands: a questionnaire survey amongst dietitians T. Dijkstra1 *, D. Gruppen2, L. Munneke2, G. Venema1. 1Beatrix Children’s Hospital, UMC Groningen, Groningen, The Netherlands, 2Student, Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands Introduction: In the Netherlands a national guideline for Inflammatory Bowel Diseases in Children is present. Exclusive enteral nutrition (EEN) for 6 weeks is recommended as first treatment in children newly diagnosed with CD. EEN consists of a polymeric formula (PF) which can be given orally or by tube. Patients are only allowed to drink water in addition to the PF. The recommendation leaves open some points which can lead to differences in practical implementations. Aim: The aim of this survey was to investigate how the guideline regarding EEN was used in Dutch hospitals treating children with CD. Methods: A questionnaire was sent to the dietetic departments of all 95 hospitals in the Netherlands. Results: Responses were received from 79 hospitals (83%) of which 48 (60%) treat children with CD. In 6/48 hospitals children with CD received exclusive tube feeding, either monomeric formula (MF; 2) or PF (4). In 3/48 centers exclusive polymeric sip feeding (PSF) was prescribed and in 38/48 units (80%) a combination of PF and PSF was used. In 50% of the prescriptions the PF and PFS consisted fiber. The duration of EEN varied from 4 6 weeks but 6 weeks in most cases (70%). Transition to a normal diet varied from 1 4 weeks, with a wide range of foods being allowed. Conclusion: In the Netherlands EEN is a commonly used therapy for the first treatment of children newly diagnosed with CD, as recommended in the guideline, but there are wide variations in protocols. P-074 Food practices and use of complementary & alternative medicine (CAM) in pediatric inflammatory bowel disease (IBD) patients in Singapore F. Ong1 *, C. Lin1, M.J. Liwanag1, M. Aw1, S.H. Quak1, S.L. Lim1, P. Li1. 1National University Hospital, Singapore Introduction: IBD patients usually make dietary changes following a flare and have a range of food beliefs. There is a lack of information about CAM and diet practices in Asian IBD patients where such practices may be different from Western countries. Aim: Aims include (i) determining the prevalence and types of CAM usage in IBD patients, (ii) the specific food practices of IBD patients and (iii) food reintroduction patterns in patients who have induced remission with enteral nutrition (Modulen). Method: Parents of children with IBD were invited to participate in a questionnaire during support groups or outpatient appointments. Information gathered included patient demographics, disease severity, medications, food patterns and CAM usage. Results: 15 subjects completed the survey, 10 had Crohn’s disease, 5 had ulcerative colitis. 5 subjects identified dietary triggers for their flare, such as fried foods, chilli, milk, gluten, sugars and certain fruits. 67% subjects have used Modulen. After taking Modulen, rice and potato were the most common foods to be reintroduced back to the diet first. 87% of patients report use of CAM. Probiotics (62%), turmeric (46%), fish oil (46%), barley (31%), green tea (31%), pomegranate (15%), wheatgrass (15%) and the Specific Carbohydrate diet (15%) were the most widely used form of CAM. Conclusion: The use of CAM is prevalent in the local IBD paediatric population. Majority of patients tell their primary physician that their child is taking CAM. Further studies to elucidate the efficacy of the more commonly used CAM such as tumeric may be warranted. P-075 Hypovitaminosis D in children with IBD assessed for bone metabolism I. Senecic-Cala1 *, V. Kusec2, I. Hojsak3, M. Dujsin4, J. Vukovic2, D. Tjesic-Drinkovic2, L. Omerza4, S. Kolacek3. 1University of Zagreb Medical School, University Hospital Centre, Zagreb, Croatia, 2University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia, 3Children’s Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia, 4University Hospital Centre Zagreb, Zagreb, Croatia Inflammatory bowel disease (IBD) may compromise skeletal integrity in children and is a recognized risk of osteoporosis in adulthood. The aim was to assess bone metabolism in children with IBD at diagnosis and after one year of follow up. There were 58 children (36 girls, 22 boys), 41 with Crohn’s disease, 17 with ulcerative colitis, aged 14.6±2.7 years (7 20). Lumbar spine dual x-ray absorptiometry (DXA), 25OH D, bone markers (osteocalcin, P1CP, CTX, crosslaps urine, osteoprotegerin) measurements by standard methods were performed. No difference in groups according to gender or diagnosis was found. DXA z-scores ( 0.67±1.28; range 3.95 to 2.47) indicating decreased bone mass (< 2) were found in 5 patients. At diagnosis hypovitaminosis D (<50 nmol/L) was found in 69% of patients. Increased bone markers (as compared to adult ranges) were observed in 75% for osteocalcin, 95% for P1CP, 98% for CTX and 45% for crosslaps urine. Osteoprotegerin was similar to adult values in 92% of patients. After one year, statistically significant increase was found for osteocalcin (0.002) and P1CP (0.001), and decrease for crosslaps urine (0.0005) and osteoprotegerin (0.03). Hypovitaminosis D was still present in 41% of cases. These results indicate that IBD in children did not considerably impair the skeleton. Increased bone markers probably indicate increased bone turnover characteristic of growth and puberty. The changes of bone markers during follow-up probably reflect recovery and continuation of growth processes without predominant bone resorption. However, hypovitaminosis D is a recognized problem and should be treated to prevent osteoporosis risk. by gest on Sptem er 4, 2016 http://eccoxfordjournals.org/ D ow nladed from