Exclusive enteral nutrition continues to be first line therapy for pediatric Crohn's disease in the era of biologics

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Navas-López, J. Blasco-Alonso, S. Lacasa Maseri, F. Girón Fernández-Crehuet, M.J. Serrano Nieto, M.I. Vicioso Recio, C. Sierra Salinas" "autores" => array:7 [ 0 => array:4 [ "nombre" => "V.M." "apellidos" => "Navas-López" "email" => array:1 [ 0 => "victor.navas@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Blasco-Alonso" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Lacasa Maseri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Girón Fernández-Crehuet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "M.J." "apellidos" => "Serrano Nieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M.I." "apellidos" => "Vicioso Recio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "C." "apellidos" => "Sierra Salinas" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Biomedical Institute of Malaga (IBIMA), Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Clinical Laboratory, Carlos Haya University Hospital, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La nutrición enteral exclusiva contínua siendo el tratamiento de primera linea en la enfermedad de Crohn pediátrica en la era de los biológicos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1206 "Ancho" => 1656 "Tamanyo" => 181984 ] ] "descripcion" => array:1 [ "en" => "Correlation between fecal calprotectin and PCDAI (Spearman's Correlation Coefficient)." ] ] ] "textoCompleto" => "IntroductionCrohn's disease (CD) is an idiopathic chronic inflammatory disorder. The natural course of Crohn's disease is characterized by flare-ups alterned with periods of remission. Controlling intestinal inflammation is crucial for preventing progressive intestinal damage and the appearance of complications.<a class="elsevierStyleCrossRef" href="#bib0205">1</a>The incidence of CD in children and adolescents is approximately 3 cases/100,000 inhabitants (range 1–8/100,000 inhab.) and this has increased in Spain and Europe during the last decade.<a class="elsevierStyleCrossRef" href="#bib0210">2</a> Up to 20% of CD patients are diagnosed before the age of 18 years. There are differences in the form of onset, natural course, and treatment regimens between adults and children. Another key difference is delayed growth, up to 46% of children and adolescents diagnosed with CD had a decrease in their growth rate before the onset of any other symptoms, and only 12% had a normal growth rate at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#bib0215">3</a> This is not only found at diagnosis, it has a variable prevalence during follow-up.<a class="elsevierStyleCrossRef" href="#bib0220">4</a> It is also important to remember that a chronic disease appearing during childhood is associated with considerable psychological morbidity that may influence personal relationships, psychosexual development, scholastic achievements and adherence to treatment.There are a wide range of therapeutic objectives that need to be achieved in active disease; these include control of inflammation, mucosal healing, modifying disease progression, preventing the adverse effects of treatment and guaranteeing suitable growth and development.<a class="elsevierStyleCrossRefs" href="#bib0225">5,6</a> Exclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids, without their side effects, in achieving mucosal and transmural remission, a situation that determines better prognosis in the following years, lower hospitalization rate and less use of biological drugs.<a class="elsevierStyleCrossRefs" href="#bib0235">7–11</a>Calprotectin is a calcium-binding protein with antimicrobial properties. Calprotectin is released from the cytoplasm of activated neutrophils, and the fecal levels increase in bowel inflammation.<a class="elsevierStyleCrossRef" href="#bib0260">12</a> Fecal calprotectin (FC) values have been correlated with endoscopic scores in adults and children with IBD. It is a non-invasive biomarker with high sensitivity and specificity that enables monitoring of inflammatory activity and prediction of clinical relapse.<a class="elsevierStyleCrossRefs" href="#bib0260">12–17</a>ObjectivesThe aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation using FC as a non-invasive inflammatory biomarker and to assess the effectiveness of concomitant medications. Another efficacy end point of this study was to determine whether early initiation of thiopurine treatment (before 8 weeks after diagnosis) vs. conventional introduction after relapse, improved long-term prognosis.Materials and methodsThis was an observational retrospective study that included all patients under 14 years of age with newly diagnosed CD in a single Pediatric Gastroenterology and Nutrition Unit between January 2002 and December 2012, and who received EEN as first line therapy. The diagnosis of CD was based on established clinical, endoscopic, histological and radiological criteria.<a class="elsevierStyleCrossRef" href="#bib0290">18</a> Patients diagnosed with ulcerative colitis, indeterminate colitis, eosinophilic colitis or infectious colitis were excluded.All patients received a polymeric formula, Modulen IBD® or Resource IBD® (the same product with different name), both prepared the same way by mixing 1700ml water with 400g product to produce 2000ml of formula (1kcal/ml). The prescribed volumes were based on Schofield equation, which predicts resting energy expenditure.<a class="elsevierStyleCrossRef" href="#bib0295">19</a> Feeds were gradually increased to target volumes in 3–5 days and patients were only allowed to drink water during treatment. EEN was given for a 6–8-week period.The data collected were age, gender, family history of inflammatory bowel disease (IBD), time from diagnosis and concomitant pharmacological treatment. Disease phenotype was determined according to the Paris classification.<a class="elsevierStyleCrossRef" href="#bib0300">20</a> All patients were assessed at the start and end of the EEN period, the variables analyzed were weight, height, body mass index (BMI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), albumin, complete blood count (CBC), FC (Calprest®, Eurospital, Italy) and Pediatric Crohn's Disease Activity Index (PCDAI).<a class="elsevierStyleCrossRefs" href="#bib0305">21,22</a> Weight and height were measured with the patient barefoot and in underwear. Samples for the determination of fecal calprotectin were collected at home by the patient the day before and were delivered refrigerated to the laboratory for immediate analysis. Clinical remission was defined as PCDAI<10 and response as a change of more than 12.5 points from baseline PCDAI after 6–8 weeks of EEN. Normal FC levels were considered to be those below 50μg/g of feces. Weight, height and BMI z scores were calculated using data from Spanish growth charts.<a class="elsevierStyleCrossRef" href="#bib0315">23</a>Statistical analysisVariables with normal distribution were expressed as mean±standard deviation and those without normal distribution were expressed as median and interquartile range (IQR). Kolmogorov–Smirnov test was used to evaluate normality of the distribution. Student's t-test and Wilcoxon signed-rank test were used for paired samples and Chi-square test was used to compare proportions. The estimation of correlations was performed using Spearman's Correlation Coefficient. To compare levels of FC and PCDAI a Kruskal Wallis test was applied, if the hypothesis of equality was rejected, groups were compared using the Mann Whitney test with Bonferroni correction. Survival analysis was performed with the Kaplan–Meier method. Comparison of survival curves between groups was performed with a log rank analysis. We considered a p<0.05 as statistically significant.ResultsPatient characteristicsForty patients were included; 24 were male (60%) and the age at diagnosis was 11.6±3.6 years (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Six patients had a family history of IBD (CD in 4 and ulcerative colitis in 2). Time from the onset of symptoms to diagnosis was 4.2 months (IQR 2.3–12.1); it was slightly lower in the patients with family history of IBD (4.7 months (IQR 2.4–12.2) vs. 3.5 months (IQR 1.4–8.5), p=0.394).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Fecal calprotectinBaseline FC levels were 680μg/g (IQR 524–796) and decreased significantly to 218μg/g (IQR 149–402), p<0.0001 after EEN. We found a high correlation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) between FC and PCDAI (rho=0.727; p<0.0001). FC was significantly higher (p=0.04) in patients with moderate and severe disease (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Combination of EEN with pharmacological treatmentAt the start of EEN, patients were receiving concomitant treatment with mesalazine (32.5%), metronidazole (17.5%) or both (45%) as adjuvant treatment (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Once the vaccination schedule had been checked and optimized, 27 of the 40 patients (67.5%) started treatment with azathioprine at a dose of 2.5–3.0mg/kg/day in a median time of 9 days (IQR 0–19). In two cases, azathioprine had to be suspended, one due to intolerance (abdominal pain and nausea) and another due to pancreatitis; both patients were switched to 6-mercaptopurine without incident.Response to EENSix patients failed to complete the 6–8 weeks of EEN; two refused to continue after 2 weeks and another four received steroids after 3 weeks due to non-response. Except for one case requiring NG tube, all patients received EEN by mouth. Duration of EEN was 6.4 weeks (IQR 6–8.1). Of the 34 patients who completed the EEN period, 32 (94% per-protocol analysis) achieved clinical remission. This percentage fell to 80% in the intention-to-treat analysis. The compliance rate was 95%. There was a significant increase in weight, albumin, hemoglobin and hematocrit levels together with a significant decrease in FC, CRP, ESR, WBC and platelets (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) at the end of EEN.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>EEN was well tolerated in all cases and no side effects were reported during the period of use. At the end of EEN, food was introduced progressively with good acceptance.We found no statistically significant differences in the response rate according to mild or moderate-to-severe PCDAI<a class="elsevierStyleCrossRef" href="#bib0305">21</a> (91% vs. 76%, p=0.136), but we found differences in response rate using new PCDAI<a class="elsevierStyleCrossRef" href="#bib0310">22</a> cut-off (90% mild, 100% moderate and 68.2% in severe CD; p=0.05). In terms of CD location, statistically significant differences in response were found (L1+L3 88% vs. L2 50% p=0.047), although only 5 patients had L2 CD location.Follow-upNineteen of the 32 patients (59.4%) who achieved clinical remission had already started early (≤8 weeks after starting the EEN) treatment with azathioprine (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). At the end of the follow-up period (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), 5 patients treated with azathioprine as maintenance therapy (26.3%) and 2 with no maintenance treatment (15.3%) continued in remission (difference of 11%; 95% confidence interval, −3.13 to 25.13%; p=0.389). We did not find differences in time to relapse between groups (8.1 months (IQR 3–18) in early azathioprine group vs. 10 months (2.6–24.6) in late azathioprine group, p=0.954). The median follow-up period was 2.9 years (IQR 1.8–4.8) in both groups.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThis study shows that EEN produces clinical and biochemical remission and weight recovery in new onset CD patients. Although we did not perform an endoscopy after the EEN, the significant decrease in the FC indicates a clear improvement in the degree of intestinal inflammation.<a class="elsevierStyleCrossRefs" href="#bib0260">12–15</a> Though the rate of mucosal healing achieved by EEN in some case reports are similar to that of anti-TNF-α and much higher than steroids<a class="elsevierStyleCrossRefs" href="#bib0245">9–11,24–26</a> they suffer from bias, as EEN is more likely to be administered to patients with recent onset or mild to moderate disease, while steroids are more likely to be administered to severe disease, and anti TNF to patients with longer duration uncontrolled disease. However, unlike steroids, EEN has a positive effect on linear growth with an increase in growth rate in the 6 months following the start of treatment and on bone mineral density.<a class="elsevierStyleCrossRefs" href="#bib0335">27–30</a>In a recent study with 34 patients,<a class="elsevierStyleCrossRef" href="#bib0255">11</a> 58% of the patients treated with EEN achieved endoscopic remission (measured by SES-CD<a class="elsevierStyleCrossRef" href="#bib0355">31</a>) and 21% showed transmural remission measured by MR enterography. These authors showed that early endoscopic remission was associated with lower rates of endoscopic relapse, less use of anti-TNF-α and fewer hospitalisations one year after diagnosis. Response was better in those with less time since diagnosis. These same authors showed that induction of remission with steroids instead of EEN increased the risk of failure to respond or loss of response to anti-TNF-α.The efficacy of EEN was first observed at the beginning of the 1970s, when it was found that the clinical and nutritional status of some patients improved after being treated with elemental formula while awaiting surgical treatment. Although the mechanisms of EEN on intestinal inflammation in CD are not fully understood, there are a number of hypotheses, including modification of the intestinal flora, elimination of the uptake of food antigens, decrease in the intestinal synthesis of inflammatory mediators due to a reduced amount of fat in the diet or the supply of micronutrients to the inflamed gut.<a class="elsevierStyleCrossRef" href="#bib0360">32</a>Analysing the data from more than 25 pediatric studies, the overall efficacy of EEN is found to be 84% (95% CI, 81–87%), although with different enteral formulas, clinical remission criteria and treatment duration. The compliance rate is very high, reaching 90% (95% CI, 88–92%). No differences in the remission rate or compliance have been found in relation to the enteral formula used (polymeric, semi-elemental or elemental), with glutamine supplements or with medium chain triglycerides.<a class="elsevierStyleCrossRef" href="#bib0365">33</a> In our series, only one type of formula was used, specific for CD, enriched with TGF-β, allowing no other food to be taken except water during the EEN period. Partial enteral nutrition (50% of calories in the form of conventional food) has been shown to be less effective than EEN.<a class="elsevierStyleCrossRef" href="#bib0370">34</a> Other approaches, such as allowing up to 20% of daily estimated calories coming from other foods, have not shown lower efficacy.<a class="elsevierStyleCrossRef" href="#bib0375">35</a>Initially it was believed that nutritional treatment was more effective in patients with ileal involvement than in those with disease located exclusively in the colon. There are currently no data to enable a correlation between response to EEN and disease phenotype.<a class="elsevierStyleCrossRef" href="#bib0380">36</a> Moreover, in our series, we found significant differences according to the location although the number of patients with exclusive colonic disease was very small.Although our study was not designed to address the impact of early thiopurine treatment on the outcome of the disease after induction we did not find differences in terms of maintenance of remission in patients treated early (≤8 weeks) vs. late (>8 weeks), see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, but patients treated earlier needed less steroids during the follow-up (p=0.001). Our results are in concordance to other studies performed in children<a class="elsevierStyleCrossRefs" href="#bib0255">11,37</a> and in adults,<a class="elsevierStyleCrossRefs" href="#bib0390">38,39</a> and against the results showed by Markovitz et al.<a class="elsevierStyleCrossRef" href="#bib0400">40</a> in a pediatric study. Probably one of the reasons for this discrepancy between pediatric studies may be because none of the patients included in Markovitz’<a class="elsevierStyleCrossRef" href="#bib0400">40</a> study received induction therapy with EEN, and is already known that the achievement of mucosal healing with steroids treatment is unlikely. However, further studies are required before any evidence-based determination can be made as to the most correct use of immunomodulator therapy in pediatric CD.This study provides valuable information on the efficacy of EEN in pediatric CD. The most important limitations are the small number of patients, which probably underestimates the effect of thiopurines and the retrospective analysis of the data, making it difficult to obtain more robust information.In conclusion, EEN administered for 6–8 weeks is effective in inducing clinical and biochemical remission, improving anthropometric parameters and decreasing the degree of mucosal inflammation. FC enables monitoring of response to EEN and control of the degree of mucosal inflammation. Patients treated early with thiopurines received less steroids during the follow-up. The EEN period is the key for updating the vaccination schedule and ordering the necessary investigations prior to starting immunosuppression treatment.Conflict of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres535722" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec556004" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres535721" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec556005" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Objectives" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 7 => array:3 [ "identificador" => "sec0025" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Patient characteristics" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Fecal calprotectin" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Combination of EEN with pharmacological treatment" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Response to EEN" ] 4 => array:2 [ "identificador" => "sec0050" "titulo" => "Follow-up" ] ] ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-11-26" "fechaAceptado" => "2014-02-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec556004" "palabras" => array:4 [ 0 => "Inflammatory bowel disease" 1 => "Crohn's disease" 2 => "Exclusive enteral nutrition" 3 => "Calprotectin" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec556005" "palabras" => array:4 [ 0 => "Enfermedad inflamatoria intestinal" 1 => "Enfermedad de Crohn" 2 => "Nutrición enteral exclusiva" 3 => "Calprotectina" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundExclusive enteral nutrition (EEN) has been shown to be more effective than corticosteroids in achieving mucosal healing without having their side effects. ObjectivesTo determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation. Materials and methodsThe medical records of patients with newly diagnosed Crohn's disease treated with EEN were reviewed retrospectively. The degree of mucosal inflammation was assessed by fecal calprotectin (FC). Remission was defined as a PCDAI<10. ResultsForty patients (24 males) were included, the age at diagnosis was 11.6±3.6 years. Of the 34 patients who completed the EEN period, 32 (94% per-protocol analysis) achieved clinical remission. This percentage fell to 80% in the intention-to-treat analysis. The compliance rate was 95%. Duration of EEN was 6.42 weeks (IQR 6.0–8.14). FC was significantly higher in patients with moderate and severe disease. Median baseline FC levels (680μg/g) decreased significantly to 218μg/g (p<0.0001) after EEN. We found a statistically significant correlation between FC and PCDAI (rho=0.727; p<0.0001). Early use of thiopurines (<8 weeks) vs. subsequent use was not associated with better outcome during the follow-up. ConclusionsEEN administered for 6–8 weeks is effective for inducing clinical remission and decreasing the degree of mucosal inflammation. We did not find differences in terms of maintenance of remission in patients treated early with thiopurines." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objectives" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa nutrición enteral exclusiva (NEE) ha demostrado ser más efectiva que los esteroides para alcanzar la curación mucosa sin sus efectos secundarios. ObjetivosDeterminar la eficacia de la NEE para inducir la remisión clínica y mejorar el grado de inflamación mucosa en pacientes con EC durante su primer brote. Material y métodosRevisión de las historias clínicas de pacientes con EC tratados con NEE durante su primer brote. El grado de inflamación mucosa se estimó mediante la calprotectina fecal (CF). Se definió remisión como PCDAI<10. ResultadosSe incluyeron 40 pacientes (24 varones) con una edad al diagnóstico de 11,6±3,6 años. La duración de la NEE fue de 6,42 semanas (RIQ 6,0–8,14). De los 34 pacientes que completaron el período de NEE, 32 (94% en el análisis por protocolo) alcanzaron la remisión clínica. Este porcentaje descendió al 80% en el análisis por intención de tratar. La tasa de cumplimiento fue del 95%. Los valores de CF fueron significativamente mas altos en pacientes con brotes moderados y graves. La CF basal fue de 680μg/g y descendió de forma significativa a 218μg/g al final del periodo de NEE (p<0,0001). Hubo correlación estadísticamente significativa entre CF y PCDAI (rho=0,727; p<0,0001). La introducción precoz del tratamiento con tiopurinas (antes de las 8 semanas) no se asoció a una mejor evolución durante el seguimiento. ConclusionesLa NEE administrada durante 6–8 semanas es efectiva para inducir la remisión clínica y mejorar el grado de inflamación mucosa. No encontramos diferencias en términos de mantenimiento de la remisión en pacientes tratados precozmente con tiopurinas." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivos" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Material y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Navas-López VM, Blasco-Alonso J, Lacasa Maseri S, Girón Fernández-Crehuet F, Serrano Nieto MJ, Vicioso Recio MI, et al. La nutrición enteral exclusiva contínua siendo el tratamiento de primera linea en la enfermedad de Crohn pediátrica en la era de los biológicos. An Pediatr (Barc). 2015;83:47–54." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1206 "Ancho" => 1656 "Tamanyo" => 181984 ] ] "descripcion" => array:1 [ "en" => "Correlation between fecal calprotectin and PCDAI (Spearman's Correlation Coefficient)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2592 "Ancho" => 1670 "Tamanyo" => 125716 ] ] "descripcion" => array:1 [ "en" => "Differences in fecal calprotectin levels according to PCDAI. (A) PCDAI: Remission ≤10; Mild 11–30; Moderate to Severe>30 points. Adapted from Ref. <a class="elsevierStyleCrossRef" href="#bib0305">21</a>. (B) PCDAI: Remission <10; Mild 10–27.5; Moderate 30–37.5; Severe>37.5 points. Adapted from Ref. <a class="elsevierStyleCrossRef" href="#bib0310">22</a>." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1314 "Ancho" => 1654 "Tamanyo" => 78757 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier (log rank) survival curve of relapse-free duration of remission. Dashed line: patients treated with azathioprine. Solid line: patients without immunomodulator treatment." ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "PCDAI, Pediatric Crohn's Disease Activity Index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; IQR, interquartile range; IBD, inflammatory bowel disease." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">24/40 (60%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age at diagnosis (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">11.6±3.6</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history of IBD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">6/40 (15%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time from onset to diagnosis (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">4.2 (IQR 2.3–12.1)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Paris classification</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">6 (15%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">5 (12.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">16 (40%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L3+L4 (extensive) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">13 (32.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">39 (97.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">B2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">1 (2.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Perianal (p) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">13 (32.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Growth retardation (G1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">11 (27.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PCDAI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PCDAI<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PCDAI<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mild \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (27.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (20%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Severe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">29 (72.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (55%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Treatment when EEN was started</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5-ASA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">13 (32.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Metronidazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">7 (17.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">5-ASA and metronidazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">18 (45%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Metronidazole and Azithromycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">1 (2.5%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">1 (2.5%)</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab861363.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Remission ≤10; Mild 11–30; Moderate to Severe*>30 points. Adapted from Ref. <a class="elsevierStyleCrossRef" href="#bib0305">21</a>." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Remission <10; Mild 10–27.5; Moderate 30–37.5; Severe>37.5 points. Adapted from Ref. <a class="elsevierStyleCrossRef" href="#bib0310">22</a>." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of patients treated with exclusive enteral nutrition." ] ] 4 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "PCDAI, Pediatric Crohn's Disease Activity Index; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; Hb, hemoglobin; Hto, hematocrit; WBC, white blood cells; IQR, interquartile range; BMI, body mass index." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Before EEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After EEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean weight z score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean height z score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.275 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean BMI z score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">PCDAI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (IQR 28–47.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (IQR 0–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">FC (μg/g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">680 (IQR 524–796) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">218 (IQR 149–402) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">CRP (mg/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33.9 (IQR 16.5–67.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 (IQR 2.4–9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">ESR (mm/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (IQR 21.5–49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (IQR 7–16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 (IQR 2.7–3.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.1 (IQR 3.7–4.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hemoglobin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.4 (IQR 9.9–12.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.8 (IQR 11.5–13.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hematocrit (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.2 (IQR 31.7–37.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (IQR 35–39.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">WBC (×103/μL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.6±3.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7±2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Platelets (×103/μL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">533±140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">443±150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab861362.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical activities before and after EEN." ] ] 5 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Early IM (≤8 weeks) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Subsequent IM (>8 weeks) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Number \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age at diagnosis (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.9±2.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11.9±3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.910 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time for diagnosis (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.4 (IQR 3.7–12.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.5 (IQR 1.4–4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/19 (21%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/13 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.530 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/19 (5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/13 (8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.655 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14/19 (74%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10/13 (77%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.052 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">L4a or L4b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/19 (47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/13 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.066 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Growth retardation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/19 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/13 (38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.219 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Perianal disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/19 (42%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/13 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.233 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Median BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16.7 (IQR 15.4–18.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16 (IQR 14–19.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.383 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Median PCDAI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">35 (IQR 27.5–42.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">40 (IQR 30–46.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.545 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean FC (μg/g) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">680±154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">596±210 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.326 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Median CRP (mg/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (IQR 16–47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 (IQR 23–85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.142 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Median ESR (mm/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 (IQR 20.7–39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 (IQR 22–62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Median Albumin (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.3 (IQR 2.9–3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (IQR 2.4–3.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.588 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean Platelets (×103/μL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">506±107 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">547±149 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.735 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High TPMT levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/13 (84.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/6 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.373 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Intermediate TPMT levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/13 (15.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/6 (33.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.373 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Follow-up</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time to relapse (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.1 (3–18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10 (2.6–24.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.954 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">12 months relapse rate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/19 (47.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/13 (53.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.719 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">18 months relapse rate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/7 (14.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/5 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.793 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">24 months relapse rate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/6 (50%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/4 (25%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.429 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean follow up (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.83 (IQR 1.1–4.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.57 (IQR 1.8–5.43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.343 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Supplementation with enteral formula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18/19 (94.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12/13 (92.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.613 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time receiving supplementation (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (IQR 6.9–22.37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10.7 (IQR 3.5–66.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.933 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Prednisone treatment during follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/19 (21%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/13 (84.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Change in CD behavior (B1 to B2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.406 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">IFX or ADA treatment during follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/19 (58%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/13 (38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.473 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Time (months) from diagnosis to starting antiTNF therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.8 (IQR 3–23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11 (IQR 8–57) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.583 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab861364.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of patients between early (<8 weeks) and subsequent (>8 weeks) immunomodulator use at diagnosis and during follow-up." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:40 [ 0 => array:3 [ "identificador" => "bib0205" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of the Crohn's disease digestive damage score, the Lémann score" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Pariente" 1 => "J. Cosnes" 2 => "S. Danese" 3 => "W.J. Sandborn" 4 => "M. Lewin" 5 => "J.G. Fletcher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.21506" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1415" "paginaFinal" => "1422" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21560202" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0210" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing incidence of pediatric inflammatory bowel disease in Spain (1996–2009): the SPIRIT registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Martín-de-Carpi" 1 => "A. Rodríguez" 2 => "E. Ramos" 3 => "S. Jiménez" 4 => "M.J. Martínez-Gómez" 5 => "E. Medina" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.22980" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "73" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22535573" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0215" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood onset inflammatory bowel disease: predictors of delayed diagnosis from the CEDATA German-language pediatric inflammatory bowel disease registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Timmer" 1 => "R. Behrens" 2 => "S. Buderus" 3 => "A. Findeisen" 4 => "A. Hauer" 5 => "K.M. Keller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2010.09.014" "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2011" "volumen" => "158" "paginaInicial" => "467" "paginaFinal" => "473" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21051046" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0220" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Growth and clinical course of children with Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.M. Griffiths" 1 => "P. Nguyen" 2 => "C. Smith" 3 => "J.H. MacMillan" 4 => "P.M. Sherman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "1993" "volumen" => "34" "paginaInicial" => "939" "paginaFinal" => "943" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8344582" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0225" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mucosal healing in inflammatory bowel diseases: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.F. Neurath" 1 => "S.P. Travis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gutjnl-2012-302830" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2012" "volumen" => "61" "paginaInicial" => "1619" "paginaFinal" => "1635" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22842618" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0230" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The potential for disease modification in Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Van Assche" 1 => "S. Vermeire" 2 => "P. Rutgeerts" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/nrgastro.2009.220" "Revista" => array:6 [ "tituloSerie" => "Nat Rev Gastroenterol Hepatol" "fecha" => "2010" "volumen" => "7" "paginaInicial" => "79" "paginaFinal" => "85" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20134489" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0235" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn's disease: a randomized controlled open-label trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Borrelli" 1 => "L. Cordischi" 2 => "M. Cirulli" 3 => "M. Paganelli" 4 => "V. Labalestra" 5 => "S. Uccini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2006.03.010" "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2006" "volumen" => "4" "paginaInicial" => "744" "paginaFinal" => "753" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16682258" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0240" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.B. Heuschkel" 1 => "C.C. Menache" 2 => "J.T. Megerian" 3 => "A.E. Baird" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2000" "volumen" => "31" "paginaInicial" => "8" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10896064" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0245" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis: enteral nutrition in active Crohn's disease in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Dziechciarz" 1 => "A. Horvath" 2 => "R. Shamir" 3 => "H. Szajewska" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2007.03431.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2007" "volumen" => "26" "paginaInicial" => "795" "paginaFinal" => "806" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17767463" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0250" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enteral nutritional therapy for induction of remission in Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Zachos" 1 => "M. Tondeur" 2 => "A.M. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2007" "paginaInicial" => "CD000542" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0255" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Exclusive enteral nutrition induces early clinical, mucosal and transmural remission in paediatric Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Z. Grover" 1 => "R. Muir" 2 => "P. Lewindon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00535-013-0815-0" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol" "fecha" => "2014" "volumen" => "49" "paginaInicial" => "638" "paginaFinal" => "645" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23636735" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0260" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fecal calprotectin is a useful marker for disease activity in pediatric patients with inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Aomatsu" 1 => "A. Yoden" 2 => "K. Matsumoto" 3 => "E. Kimura" 4 => "K. Inoue" 5 => "A. Andoh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-011-1633-y" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2011" "volumen" => "56" "paginaInicial" => "2372" "paginaFinal" => "2377" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21394462" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0265" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crohn's disease activity assessed by fecal calprotectin and lactoferrin: correlation with Crohn's disease activity index and endoscopic findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Sipponen" 1 => "E. Savilahti" 2 => "K.L. Kolho" 3 => "H. Nuutinen" 4 => "U. Turunen" 5 => "M. Färkkilä" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.20312" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "40" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18022866" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0270" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationships between disease activity and serum and fecal biomarkers in patients with Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Jones" 1 => "E.V. Loftus Jr." 2 => "R. Panaccione" 3 => "L.S. Chen" 4 => "S. Peterson" 5 => "J. McConnell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2008.06.010" "Revista" => array:7 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2008" "volumen" => "6" "paginaInicial" => "1218" "paginaFinal" => "1224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18799360" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0735109704014457" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0275" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.D. Lewis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2010.11.058" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2011" "volumen" => "140" "paginaInicial" => "1817" "paginaFinal" => "1826" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21530748" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0280" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fecal calprotectin: a quantitative marker of colonic inflammation in children with inflammatory bowel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "U.L. Fagerberg" 1 => "L. Lööf" 2 => "J. Lindholm" 3 => "L.O. Hansson" 4 => "Y. Finkel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MPG.0b013e31810e75a9" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "414" "paginaFinal" => "420" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18030206" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0285" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "U.L. Fagerberg" 1 => "L. Lööf" 2 => "U. Myrdal" 3 => "L. Hansson" 4 => "Y. Finkel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2005" "volumen" => "40" "paginaInicial" => "450" "paginaFinal" => "455" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15795593" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0290" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory bowel disease in children and adolescents: recommendations for diagnosis—the Porto criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "IBD Working Group of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15990620" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0295" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting basal metabolic rate, new standards and review of previous work" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.N. Schofield" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Hum Nutr Clin Nutr" "fecha" => "1985" "volumen" => "39" "paginaInicial" => "5" "paginaFinal" => "41" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4044297" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0300" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Levine" 1 => "A. Griffiths" 2 => "J. Markowitz" 3 => "D.C. Wilson" 4 => "D. Turner" 5 => "R.K. Russell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.21493" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2011" "volumen" => "17" "paginaInicial" => "1314" "paginaFinal" => "1321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21560194" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0305" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and validation of a pediatric Crohn's disease activity index" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Hyams" 1 => "G.D. Ferry" 2 => "F.S. Mandel" 3 => "J.D. Gryboski" 4 => "P.M. Kibort" 5 => "B.S. Kirschner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "1991" "volumen" => "12" "paginaInicial" => "439" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1678008" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0310" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Appraisal of the pediatric Crohn's disease activity index on four prospectively collected datasets: recommended cutoff values and clinimetric properties" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Turner" 1 => "A.M. Griffiths" 2 => "T.D. Walters" 3 => "T. Seah" 4 => "J. Markowitz" 5 => "M. Pfefferkorn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2010.143" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2010" "volumen" => "105" "paginaInicial" => "2085" "paginaFinal" => "2092" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20372111" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0315" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudios espanoles de crecimiento" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Carrascosa" 1 => "J.M. Fernández" 2 => "M. Fernández" 3 => "J.P. López-Siguero" 4 => "D. López" 5 => "E. Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2010" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0320" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Berni Canani" 1 => "G. Terrin" 2 => "O. Borrelli" 3 => "M.T. Romano" 4 => "F. Manguso" 5 => "A. Coruzzo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.dld.2005.10.005" "Revista" => array:6 [ "tituloSerie" => "Dig Liver Dis" "fecha" => "2006" "volumen" => "38" "paginaInicial" => "381" "paginaFinal" => "387" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16301010" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0325" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymeric nutrition as the primary therapy in children with small bowel Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Beattie" 1 => "E.J. Schiffrin" 2 => "A. Donnet-Hughes" 3 => "A.C. Huggett" 4 => "P. Domizio" 5 => "T.T. MacDonald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "1994" "volumen" => "8" "paginaInicial" => "609" "paginaFinal" => "615" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7696450" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0330" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Fell" 1 => "M. Paintin" 2 => "F. Arnaud-Battandier" 3 => "R.M. Beattie" 4 => "A. Hollis" 5 => "P. Kitching" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2000" "volumen" => "14" "paginaInicial" => "281" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10735920" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0335" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of exclusive enteral nutrition is just as effective as corticosteroids in newly diagnosed pediatric Crohn’ disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Soo" 1 => "B. Malik" 2 => "J. Turner" 3 => "R. Persad" 4 => "E. Wine" 5 => "K. Siminoski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-013-2855-y" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2013" "volumen" => "58" "paginaInicial" => "3584" "paginaFinal" => "3591" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24026403" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0340" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Remission induced by an elemental diet in small bowel Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.R. Sanderson" 1 => "S. Udeen" 2 => "P.S. Davies" 3 => "M.O. Savage" 4 => "J.A. Walker-Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dis Child" "fecha" => "1987" "volumen" => "62" "paginaInicial" => "123" "paginaFinal" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3548602" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0345" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interventions for growth failure in childhood Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.A. Newby" 1 => "A. Sawczenko" 2 => "A.G. Thomas" 3 => "D. Wilson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2005" "paginaInicial" => "CD003873" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0350" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dietary intake and nutritional treatment in childhood Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.G. Thomas" 1 => "F. Taylor" 2 => "V. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Gastroenterol Nutr" "fecha" => "1993" "volumen" => "17" "paginaInicial" => "75" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8350215" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0355" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SESCD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Daperno" 1 => "G. D’Haens" 2 => "G. Van Assche" 3 => "F. Baert" 4 => "P. Bulois" 5 => "V. Maunoury" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endosc" "fecha" => "2004" "volumen" => "60" "paginaInicial" => "505" "paginaFinal" => "512" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15472670" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0360" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enteral nutrition in the management of Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.M. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Parenter Enteral Nutr" "fecha" => "2005" "volumen" => "29" "paginaInicial" => "S108" "paginaFinal" => "S112" ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0365" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento general del brote de enfermedad de Crohn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V.M. Navas-López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Enfermedad inflamatoria intestinal en pediatría" "paginaInicial" => "257" "paginaFinal" => "268" "serieFecha" => "2012" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0370" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of active Crohn's disease in children using partial enteral nutrition with liquid formula: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Johnson" 1 => "S. Macdonald" 2 => "S.M. Hill" 3 => "A. Thomas" 4 => "M.S. Murphy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gut.2004.062554" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2006" "volumen" => "55" "paginaInicial" => "356" "paginaFinal" => "361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16162683" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0375" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International survey of enteral nutrition protocols used in children with Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.E. Whitten" 1 => "P. Rogers" 2 => "C.Y. Ooi" 3 => "A.S. Day" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1751-2980.2011.00558.x" "Revista" => array:6 [ "tituloSerie" => "J Dig Dis" "fecha" => "2012" "volumen" => "13" "paginaInicial" => "107" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22257479" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0380" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of exclusive enteral nutrition for induction of remission in children with Crohn's disease demonstrates that disease phenotype does not influence clinical remission" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Buchanan" 1 => "W.W. Gaunt" 2 => "T. Cardigan" 3 => "V. Garrick" 4 => "P. McGrogan" 5 => "R.K. Russell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2009.04067.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2009" "volumen" => "30" "paginaInicial" => "501" "paginaFinal" => "507" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19549288" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0385" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pediatric IBD collaborative research group. Effect of early immunomodulator use in moderate to severe pediatric Crohn disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Punati" 1 => "J. Markowitz" 2 => "T. Lerer" 3 => "J. Hyams" 4 => "S. Kugathasan" 5 => "A. Griffiths" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ibd.20412" "Revista" => array:6 [ "tituloSerie" => "Inflamm Bowel Dis" "fecha" => "2008" "volumen" => "14" "paginaInicial" => "949" "paginaFinal" => "954" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18306311" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0390" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early azathioprine therapy is no more effective than placebo for newly diagnosed Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Panés" 1 => "A. López-Sanromán" 2 => "F. Bermejo" 3 => "V. García-Sánchez" 4 => "M. Esteve" 5 => "Y. Torres" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2013.06.009" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2013" "volumen" => "145" "paginaInicial" => "766" "paginaFinal" => "774" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23770132" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0395" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early administration of azathioprine versus conventional management of crohn's disease: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Cosnes" 1 => "A. Bourrier" 2 => "D. Laharie" 3 => "S. Nahon" 4 => "Y. Bouhnik" 5 => "F. Carbonnel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2013.04.048" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2013" "volumen" => "145" "paginaInicial" => "758" "paginaFinal" => "765" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23644079" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0400" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Markowitz" 1 => "K. Grancher" 2 => "N. Kohn" 3 => "M. Lesser" 4 => "F. Daum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2000" "volumen" => "119" "paginaInicial" => "895" "paginaFinal" => "902" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11040176" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgments" "texto" => "We thank Prof. Arie Levine MD and Prof. Julián Panés MD, PhD for their helpful contributions to this manuscript." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000001/v1_201507250123/S2341287915000198/v1_201507250123/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000001/v1_201507250123/S2341287915000198/v1_201507250123/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000198?idApp=UINPBA00005H"]

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Exclusive enteral nutrition continues to be first line therapy for pediatric Crohn's disease in the era of biologics

La nutrición enteral exclusiva contínua siendo el tratamiento de primera linea en la enfermedad de Crohn pediátrica en la era de los biológicos

V.M. Navas-Lópeza,b,

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victor.navas@gmail.com

Corresponding author.

, J. Blasco-Alonsoa,b, S. Lacasa Maseria, F. Girón Fernández-Crehueta, M.J. Serrano Nietoa, M.I. Vicioso Recioc, C. Sierra Salinasa,b

a Pediatric Gastroenterology and Nutrition Unit, Hospital Materno Infantil, Málaga, Spain

b Biomedical Institute of Malaga (IBIMA), Málaga, Spain

c Clinical Laboratory, Carlos Haya University Hospital, Málaga, Spain

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values have been correlated with endoscopic scores in adults and children with IBD&#46; It is a non-invasive biomarker with high sensitivity and specificity that enables monitoring of inflammatory activity and prediction of clinical relapse&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#8211;17</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objectives</span><p id="par0025" class="elsevierStylePara elsevierViewall">The aims of this study were to determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation using FC as a non-invasive inflammatory biomarker and to assess the effectiveness of concomitant medications&#46; Another efficacy end point of this study was to determine whether early initiation of thiopurine treatment &#40;before 8 weeks after diagnosis&#41; vs&#46; conventional introduction after relapse&#44; improved long-term prognosis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was an observational retrospective study that included all patients under 14 years of age with newly diagnosed CD in a single Pediatric Gastroenterology and Nutrition Unit between January 2002 and December 2012&#44; and who received EEN as first line therapy&#46; The diagnosis of CD was based on established clinical&#44; endoscopic&#44; histological and radiological criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a> Patients diagnosed with ulcerative colitis&#44; indeterminate colitis&#44; eosinophilic colitis or infectious colitis were excluded&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">All patients received a polymeric formula&#44; Modulen IBD<span class="elsevierStyleSup">&#174;</span> or Resource IBD<span class="elsevierStyleSup">&#174;</span> &#40;the same product with different name&#41;&#44; both prepared the same way by mixing 1700<span class="elsevierStyleHsp" style=""></span>ml water with 400<span class="elsevierStyleHsp" style=""></span>g product to produce 2000<span class="elsevierStyleHsp" style=""></span>ml of formula &#40;1<span class="elsevierStyleHsp" style=""></span>kcal&#47;ml&#41;&#46; The prescribed volumes were based on Schofield equation&#44; which predicts resting energy expenditure&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a> Feeds were gradually increased to target volumes in 3&#8211;5 days and patients were only allowed to drink water during treatment&#46; EEN was given for a 6&#8211;8-week period&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The data collected were age&#44; gender&#44; family history of inflammatory bowel disease &#40;IBD&#41;&#44; time from diagnosis and concomitant pharmacological treatment&#46; Disease phenotype was determined according to the Paris classification&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">20</span></a> All patients were assessed at the start and end of the EEN period&#44; the variables analyzed were weight&#44; height&#44; body mass index &#40;BMI&#41;&#44; C-reactive protein &#40;CRP&#41;&#44; erythrocyte sedimentation rate &#40;ESR&#41;&#44; albumin&#44; complete blood count &#40;CBC&#41;&#44; FC &#40;Calprest<span class="elsevierStyleSup">&#174;</span>&#44; Eurospital&#44; Italy&#41; and Pediatric Crohn&#39;s Disease Activity Index &#40;PCDAI&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">21&#44;22</span></a> Weight and height were measured with the patient barefoot and in underwear&#46; Samples for the determination of fecal calprotectin were collected at home by the patient the day before and were delivered refrigerated to the laboratory for immediate analysis&#46; Clinical remission was defined as PCDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10 and response as a change of more than 12&#46;5 points from baseline PCDAI after 6&#8211;8 weeks of EEN&#46; Normal FC levels were considered to be those below 50<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g of feces&#46; Weight&#44; height and BMI <span class="elsevierStyleItalic">z</span> scores were calculated using data from Spanish growth charts&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a></p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Variables with normal distribution were expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation and those without normal distribution were expressed as median and interquartile range &#40;IQR&#41;&#46; Kolmogorov&#8211;Smirnov test was used to evaluate normality of the distribution&#46; Student&#39;s <span class="elsevierStyleItalic">t</span>-test and Wilcoxon signed-rank test were used for paired samples and Chi-square test was used to compare proportions&#46; The estimation of correlations was performed using Spearman&#39;s Correlation Coefficient&#46; To compare levels of FC and PCDAI a Kruskal Wallis test was applied&#44; if the hypothesis of equality was rejected&#44; groups were compared using the Mann Whitney test with Bonferroni correction&#46; Survival analysis was performed with the Kaplan&#8211;Meier method&#46; Comparison of survival curves between groups was performed with a log rank analysis&#46; We considered a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 as statistically significant&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patient characteristics</span><p id="par0050" class="elsevierStylePara elsevierViewall">Forty patients were included&#59; 24 were male &#40;60&#37;&#41; and the age at diagnosis was 11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 years &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Six patients had a family history of IBD &#40;CD in 4 and ulcerative colitis in 2&#41;&#46; Time from the onset of symptoms to diagnosis was 4&#46;2 months &#40;IQR 2&#46;3&#8211;12&#46;1&#41;&#59; it was slightly lower in the patients with family history of IBD &#40;4&#46;7 months &#40;IQR 2&#46;4&#8211;12&#46;2&#41; vs&#46; 3&#46;5 months &#40;IQR 1&#46;4&#8211;8&#46;5&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;394&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Fecal calprotectin</span><p id="par0055" class="elsevierStylePara elsevierViewall">Baseline FC levels were 680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;IQR 524&#8211;796&#41; and decreased significantly to 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;IQR 149&#8211;402&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001 after EEN&#46; We found a high correlation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; between FC and PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;727&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; FC was significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41; in patients with moderate and severe disease &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Combination of EEN with pharmacological treatment</span><p id="par0060" class="elsevierStylePara elsevierViewall">At the start of EEN&#44; patients were receiving concomitant treatment with mesalazine &#40;32&#46;5&#37;&#41;&#44; metronidazole &#40;17&#46;5&#37;&#41; or both &#40;45&#37;&#41; as adjuvant treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Once the vaccination schedule had been checked and optimized&#44; 27 of the 40 patients &#40;67&#46;5&#37;&#41; started treatment with azathioprine at a dose of 2&#46;5&#8211;3&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;day in a median time of 9 days &#40;IQR 0&#8211;19&#41;&#46; In two cases&#44; azathioprine had to be suspended&#44; one due to intolerance &#40;abdominal pain and nausea&#41; and another due to pancreatitis&#59; both patients were switched to 6-mercaptopurine without incident&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Response to EEN</span><p id="par0065" class="elsevierStylePara elsevierViewall">Six patients failed to complete the 6&#8211;8 weeks of EEN&#59; two refused to continue after 2 weeks and another four received steroids after 3 weeks due to non-response&#46; Except for one case requiring NG tube&#44; all patients received EEN by mouth&#46; Duration of EEN was 6&#46;4 weeks &#40;IQR 6&#8211;8&#46;1&#41;&#46; Of the 34 patients who completed the EEN period&#44; 32 &#40;94&#37; per-protocol analysis&#41; achieved clinical remission&#46; This percentage fell to 80&#37; in the intention-to-treat analysis&#46; The compliance rate was 95&#37;&#46; There was a significant increase in weight&#44; albumin&#44; hemoglobin and hematocrit levels together with a significant decrease in FC&#44; CRP&#44; ESR&#44; WBC and platelets &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; at the end of EEN&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">EEN was well tolerated in all cases and no side effects were reported during the period of use&#46; At the end of EEN&#44; food was introduced progressively with good acceptance&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We found no statistically significant differences in the response rate according to mild or moderate-to-severe PCDAI<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a> &#40;91&#37; vs&#46; 76&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;136&#41;&#44; but we found differences in response rate using new PCDAI<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a> cut-off &#40;90&#37; mild&#44; 100&#37; moderate and 68&#46;2&#37; in severe CD&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In terms of CD location&#44; statistically significant differences in response were found &#40;L1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L3 88&#37; vs&#46; L2 50&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;047&#41;&#44; although only 5 patients had L2 CD location&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Follow-up</span><p id="par0080" class="elsevierStylePara elsevierViewall">Nineteen of the 32 patients &#40;59&#46;4&#37;&#41; who achieved clinical remission had already started early &#40;&#8804;8 weeks after starting the EEN&#41; treatment with azathioprine &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; At the end of the follow-up period &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; 5 patients treated with azathioprine as maintenance therapy &#40;26&#46;3&#37;&#41; and 2 with no maintenance treatment &#40;15&#46;3&#37;&#41; continued in remission &#40;difference of 11&#37;&#59; 95&#37; confidence interval&#44; &#8722;3&#46;13 to 25&#46;13&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;389&#41;&#46; We did not find differences in time to relapse between groups &#40;8&#46;1 months &#40;IQR 3&#8211;18&#41; in early azathioprine group vs&#46; 10 months &#40;2&#46;6&#8211;24&#46;6&#41; in late azathioprine group&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;954&#41;&#46; The median follow-up period was 2&#46;9 years &#40;IQR 1&#46;8&#8211;4&#46;8&#41; in both groups&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study shows that EEN produces clinical and biochemical remission and weight recovery in new onset CD patients&#46; Although we did not perform an endoscopy after the EEN&#44; the significant decrease in the FC indicates a clear improvement in the degree of intestinal inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">12&#8211;15</span></a> Though the rate of mucosal healing achieved by EEN in some case reports are similar to that of anti-TNF-&#945; and much higher than steroids<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9&#8211;11&#44;24&#8211;26</span></a> they suffer from bias&#44; as EEN is more likely to be administered to patients with recent onset or mild to moderate disease&#44; while steroids are more likely to be administered to severe disease&#44; and anti TNF to patients with longer duration uncontrolled disease&#46; However&#44; unlike steroids&#44; EEN has a positive effect on linear growth with an increase in growth rate in the 6 months following the start of treatment and on bone mineral density&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27&#8211;30</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In a recent study with 34 patients&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a> 58&#37; of the patients treated with EEN achieved endoscopic remission &#40;measured by SES-CD<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#41; and 21&#37; showed transmural remission measured by MR enterography&#46; These authors showed that early endoscopic remission was associated with lower rates of endoscopic relapse&#44; less use of anti-TNF-&#945; and fewer hospitalisations one year after diagnosis&#46; Response was better in those with less time since diagnosis&#46; These same authors showed that induction of remission with steroids instead of EEN increased the risk of failure to respond or loss of response to anti-TNF-&#945;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The efficacy of EEN was first observed at the beginning of the 1970s&#44; when it was found that the clinical and nutritional status of some patients improved after being treated with elemental formula while awaiting surgical treatment&#46; Although the mechanisms of EEN on intestinal inflammation in CD are not fully understood&#44; there are a number of hypotheses&#44; including modification of the intestinal flora&#44; elimination of the uptake of food antigens&#44; decrease in the intestinal synthesis of inflammatory mediators due to a reduced amount of fat in the diet or the supply of micronutrients to the inflamed gut&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Analysing the data from more than 25 pediatric studies&#44; the overall efficacy of EEN is found to be 84&#37; &#40;95&#37; CI&#44; 81&#8211;87&#37;&#41;&#44; although with different enteral formulas&#44; clinical remission criteria and treatment duration&#46; The compliance rate is very high&#44; reaching 90&#37; &#40;95&#37; CI&#44; 88&#8211;92&#37;&#41;&#46; No differences in the remission rate or compliance have been found in relation to the enteral formula used &#40;polymeric&#44; semi-elemental or elemental&#41;&#44; with glutamine supplements or with medium chain triglycerides&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a> In our series&#44; only one type of formula was used&#44; specific for CD&#44; enriched with TGF-&#946;&#44; allowing no other food to be taken except water during the EEN period&#46; Partial enteral nutrition &#40;50&#37; of calories in the form of conventional food&#41; has been shown to be less effective than EEN&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> Other approaches&#44; such as allowing up to 20&#37; of daily estimated calories coming from other foods&#44; have not shown lower efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Initially it was believed that nutritional treatment was more effective in patients with ileal involvement than in those with disease located exclusively in the colon&#46; There are currently no data to enable a correlation between response to EEN and disease phenotype&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> Moreover&#44; in our series&#44; we found significant differences according to the location although the number of patients with exclusive colonic disease was very small&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Although our study was not designed to address the impact of early thiopurine treatment on the outcome of the disease after induction we did not find differences in terms of maintenance of remission in patients treated early &#40;&#8804;8 weeks&#41; vs&#46; late &#40;&#62;8 weeks&#41;&#44; see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#44; but patients treated earlier needed less steroids during the follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Our results are in concordance to other studies performed in children<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;37</span></a> and in adults&#44;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">38&#44;39</span></a> and against the results showed by Markovitz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> in a pediatric study&#46; Probably one of the reasons for this discrepancy between pediatric studies may be because none of the patients included in Markovitz&#8217;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> study received induction therapy with EEN&#44; and is already known that the achievement of mucosal healing with steroids treatment is unlikely&#46; However&#44; further studies are required before any evidence-based determination can be made as to the most correct use of immunomodulator therapy in pediatric CD&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">This study provides valuable information on the efficacy of EEN in pediatric CD&#46; The most important limitations are the small number of patients&#44; which probably underestimates the effect of thiopurines and the retrospective analysis of the data&#44; making it difficult to obtain more robust information&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In conclusion&#44; EEN administered for 6&#8211;8 weeks is effective in inducing clinical and biochemical remission&#44; improving anthropometric parameters and decreasing the degree of mucosal inflammation&#46; FC enables monitoring of response to EEN and control of the degree of mucosal inflammation&#46; Patients treated early with thiopurines received less steroids during the follow-up&#46; The EEN period is the key for updating the vaccination schedule and ordering the necessary investigations prior to starting immunosuppression treatment&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Exclusive enteral nutrition &#40;EEN&#41; has been shown to be more effective than corticosteroids in achieving mucosal healing without having their side effects&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The medical records of patients with newly diagnosed Crohn&#39;s disease treated with EEN were reviewed retrospectively&#46; The degree of mucosal inflammation was assessed by fecal calprotectin &#40;FC&#41;&#46; Remission was defined as a PCDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Forty patients &#40;24 males&#41; were included&#44; the age at diagnosis was 11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 years&#46; Of the 34 patients who completed the EEN period&#44; 32 &#40;94&#37; per-protocol analysis&#41; achieved clinical remission&#46; This percentage fell to 80&#37; in the intention-to-treat analysis&#46; The compliance rate was 95&#37;&#46; Duration of EEN was 6&#46;42 weeks &#40;IQR 6&#46;0&#8211;8&#46;14&#41;&#46; FC was significantly higher in patients with moderate and severe disease&#46; Median baseline FC levels &#40;680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g&#41; decreased significantly to 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; after EEN&#46; We found a statistically significant correlation between FC and PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;727&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Early use of thiopurines &#40;&#60;8 weeks&#41; vs&#46; subsequent use was not associated with better outcome during the follow-up&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">EEN administered for 6&#8211;8 weeks is effective for inducing clinical remission and decreasing the degree of mucosal inflammation&#46; We did not find differences in terms of maintenance of remission in patients treated early with thiopurines&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objectives"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materials and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La nutrici&#243;n enteral exclusiva &#40;NEE&#41; ha demostrado ser m&#225;s efectiva que los esteroides para alcanzar la curaci&#243;n mucosa sin sus efectos secundarios&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar la eficacia de la NEE para inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n mucosa en pacientes con EC durante su primer brote&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n de las historias cl&#237;nicas de pacientes con EC tratados con NEE durante su primer brote&#46; El grado de inflamaci&#243;n mucosa se estim&#243; mediante la calprotectina fecal &#40;CF&#41;&#46; Se defini&#243; remisi&#243;n como PCDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 40 pacientes &#40;24 varones&#41; con una edad al diagn&#243;stico de 11&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;6 a&#241;os&#46; La duraci&#243;n de la NEE fue de 6&#44;42 semanas &#40;RIQ 6&#44;0&#8211;8&#44;14&#41;&#46; De los 34 pacientes que completaron el per&#237;odo de NEE&#44; 32 &#40;94&#37; en el an&#225;lisis por protocolo&#41; alcanzaron la remisi&#243;n cl&#237;nica&#46; Este porcentaje descendi&#243; al 80&#37; en el an&#225;lisis por intenci&#243;n de tratar&#46; La tasa de cumplimiento fue del 95&#37;&#46; Los valores de CF fueron significativamente mas altos en pacientes con brotes moderados y graves&#46; La CF basal fue de 680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g y descendi&#243; de forma significativa a 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g al final del periodo de NEE &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Hubo correlaci&#243;n estad&#237;sticamente significativa entre CF y PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;727&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; La introducci&#243;n precoz del tratamiento con tiopurinas &#40;antes de las 8 semanas&#41; no se asoci&#243; a una mejor evoluci&#243;n durante el seguimiento&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La NEE administrada durante 6&#8211;8 semanas es efectiva para inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n mucosa&#46; No encontramos diferencias en t&#233;rminos de mantenimiento de la remisi&#243;n en pacientes tratados precozmente con tiopurinas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Material y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Navas-L&#243;pez VM&#44; Blasco-Alonso J&#44; Lacasa Maseri S&#44; Gir&#243;n Fern&#225;ndez-Crehuet F&#44; Serrano Nieto MJ&#44; Vicioso Recio MI&#44; et al&#46; La nutrici&#243;n enteral exclusiva cont&#237;nua siendo el tratamiento de primera linea en la enfermedad de Crohn pedi&#225;trica en la era de los biol&#243;gicos&#46; An Pediatr &#40;Barc&#41;&#46; 2015&#59;83&#58;47&#8211;54&#46;</p>"
      ]
    ]
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        "tipo" => "MULTIMEDIAFIGURA"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between fecal calprotectin and PCDAI &#40;Spearman&#39;s Correlation Coefficient&#41;&#46;</p>"
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        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Differences in fecal calprotectin levels according to PCDAI&#46; &#40;A&#41; PCDAI&#58; Remission &#8804;10&#59; Mild 11&#8211;30&#59; Moderate to Severe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30 points&#46; Adapted from Ref&#46; <a class="elsevierStyleCrossRef" href="#bib0305">21</a>&#46; &#40;B&#41; PCDAI&#58; Remission &#60;10&#59; Mild 10&#8211;27&#46;5&#59; Moderate 30&#8211;37&#46;5&#59; Severe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>37&#46;5 points&#46; Adapted from Ref&#46; <a class="elsevierStyleCrossRef" href="#bib0310">22</a>&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Kaplan&#8211;Meier &#40;log rank&#41; survival curve of relapse-free duration of remission&#46; Dashed line&#58; patients treated with azathioprine&#46; Solid line&#58; patients without immunomodulator treatment&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">PCDAI&#44; Pediatric Crohn&#39;s Disease Activity Index&#59; CRP&#44; C-reactive protein&#59; ESR&#44; erythrocyte sedimentation rate&#59; IQR&#44; interquartile range&#59; IBD&#44; inflammatory bowel disease&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Males</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">24&#47;40 &#40;60&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age at diagnosis &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Family history of IBD</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">6&#47;40 &#40;15&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Time from onset to diagnosis &#40;months&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">4&#46;2 &#40;IQR 2&#46;3&#8211;12&#46;1&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Paris classification</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">6 &#40;15&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">5 &#40;12&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">16 &#40;40&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4 &#40;extensive&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">13 &#40;32&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">39 &#40;97&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">1 &#40;2&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perianal &#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">13 &#40;32&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Growth retardation &#40;G1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">11 &#40;27&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCDAI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCDAI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCDAI<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mild&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;27&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;72&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Treatment when EEN was started</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-ASA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">13 &#40;32&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metronidazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">7 &#40;17&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-ASA and metronidazole&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">18 &#40;45&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metronidazole and Azithromycin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">1 &#40;2&#46;5&#37;&#41;</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">1 &#40;2&#46;5&#37;&#41;</td></tr></tbody></table>
                  """
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          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Remission &#8804;10&#59; Mild 11&#8211;30&#59; Moderate to Severe&#42;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30 points&#46; Adapted from Ref&#46; <a class="elsevierStyleCrossRef" href="#bib0305">21</a>&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Remission &#60;10&#59; Mild 10&#8211;27&#46;5&#59; Moderate 30&#8211;37&#46;5&#59; Severe<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>37&#46;5 points&#46; Adapted from Ref&#46; <a class="elsevierStyleCrossRef" href="#bib0310">22</a>&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Characteristics of patients treated with exclusive enteral nutrition&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">PCDAI&#44; Pediatric Crohn&#39;s Disease Activity Index&#59; CRP&#44; C-reactive protein&#59; ESR&#44; erythrocyte sedimentation rate&#59; Hb&#44; hemoglobin&#59; Hto&#44; hematocrit&#59; WBC&#44; white blood cells&#59; IQR&#44; interquartile range&#59; BMI&#44; body mass index&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Before EEN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">After EEN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mean weight <span class="elsevierStyleItalic">z</span> score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mean height <span class="elsevierStyleItalic">z</span> score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;275&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mean BMI <span class="elsevierStyleItalic">z</span> score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PCDAI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;IQR 28&#8211;47&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;IQR 0&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">FC &#40;&#956;g&#47;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">680 &#40;IQR 524&#8211;796&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">218 &#40;IQR 149&#8211;402&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CRP &#40;mg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33&#46;9 &#40;IQR 16&#46;5&#8211;67&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1 &#40;IQR 2&#46;4&#8211;9&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">ESR &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29 &#40;IQR 21&#46;5&#8211;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;IQR 7&#8211;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Albumin &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2 &#40;IQR 2&#46;7&#8211;3&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;1 &#40;IQR 3&#46;7&#8211;4&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hemoglobin &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;4 &#40;IQR 9&#46;9&#8211;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;8 &#40;IQR 11&#46;5&#8211;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hematocrit &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;2 &#40;IQR 31&#46;7&#8211;37&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;IQR 35&#8211;39&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">WBC &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Platelets &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">533<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">443<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Baseline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Early IM &#40;&#8804;8 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Subsequent IM &#40;&#62;8 weeks&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Number</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age at diagnosis &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Time for diagnosis &#40;months&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;4 &#40;IQR 3&#46;7&#8211;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;5 &#40;IQR 1&#46;4&#8211;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;19 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;530&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;19 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;13 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#47;19 &#40;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;13 &#40;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L4a or L4b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;19 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Growth retardation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;19 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;13 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Perianal disease</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;19 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;13 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Median BMI &#40;kg</span>&#47;<span class="elsevierStyleItalic">m</span><span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;7 &#40;IQR 15&#46;4&#8211;18&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;IQR 14&#8211;19&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Median PCDAI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;IQR 27&#46;5&#8211;42&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;IQR 30&#8211;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mean FC &#40;&#956;g&#47;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">680<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;326&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Median CRP &#40;mg&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;IQR 16&#8211;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;IQR 23&#8211;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Median ESR &#40;mm&#47;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;IQR 20&#46;7&#8211;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;IQR 22&#8211;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Median Albumin &#40;g&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;3 &#40;IQR 2&#46;9&#8211;3&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;IQR 2&#46;4&#8211;3&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Mean Platelets &#40;&#215;10</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">3</span></span><span class="elsevierStyleItalic">&#47;&#956;L&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">506<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">547<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;735&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">High TPMT levels</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;13 &#40;84&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;6 &#40;66&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Intermediate TPMT levels</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;6 &#40;33&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Follow-up</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Time to relapse &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;1 &#40;3&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;2&#46;6&#8211;24&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;954&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>12 months relapse rate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;19 &#40;47&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;13 &#40;53&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;719&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>18 months relapse rate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;7 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;5 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>24 months relapse rate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;6 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;4 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean follow up &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;83 &#40;IQR 1&#46;1&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;57 &#40;IQR 1&#46;8&#8211;5&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Supplementation with enteral formula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#47;19 &#40;94&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#47;13 &#40;92&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Time receiving supplementation &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;IQR 6&#46;9&#8211;22&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;7 &#40;IQR 3&#46;5&#8211;66&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prednisone treatment during follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;19 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;13 &#40;84&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Change in CD behavior &#40;B1 to B2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;406&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IFX or ADA treatment during follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;19 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;13 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Time &#40;months&#41; from diagnosis to starting antiTNF therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;8 &#40;IQR 3&#8211;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;IQR 8&#8211;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Comparison of patients between early &#40;&#60;8 weeks&#41; and subsequent &#40;&#62;8 weeks&#41; immunomodulator use at diagnosis and during follow-up&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of the Crohn&#39;s disease digestive damage score&#44; the L&#233;mann score"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Pariente"
                            1 => "J&#46; Cosnes"
                            2 => "S&#46; Danese"
                            3 => "W&#46;J&#46; Sandborn"
                            4 => "M&#46; Lewin"
                            5 => "J&#46;G&#46; Fletcher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.21506"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "1415"
                        "paginaFinal" => "1422"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21560202"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increasing incidence of pediatric inflammatory bowel disease in Spain &#40;1996&#8211;2009&#41;&#58; the SPIRIT registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Mart&#237;n-de-Carpi"
                            1 => "A&#46; Rodr&#237;guez"
                            2 => "E&#46; Ramos"
                            3 => "S&#46; Jim&#233;nez"
                            4 => "M&#46;J&#46; Mart&#237;nez-G&#243;mez"
                            5 => "E&#46; Medina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.22980"
                      "Revista" => array:6 [
                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "73"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22535573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Childhood onset inflammatory bowel disease&#58; predictors of delayed diagnosis from the CEDATA German-language pediatric inflammatory bowel disease registry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Timmer"
                            1 => "R&#46; Behrens"
                            2 => "S&#46; Buderus"
                            3 => "A&#46; Findeisen"
                            4 => "A&#46; Hauer"
                            5 => "K&#46;M&#46; Keller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2010.09.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2011"
                        "volumen" => "158"
                        "paginaInicial" => "467"
                        "paginaFinal" => "473"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21051046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Growth and clinical course of children with Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;M&#46; Griffiths"
                            1 => "P&#46; Nguyen"
                            2 => "C&#46; Smith"
                            3 => "J&#46;H&#46; MacMillan"
                            4 => "P&#46;M&#46; Sherman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "1993"
                        "volumen" => "34"
                        "paginaInicial" => "939"
                        "paginaFinal" => "943"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8344582"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mucosal healing in inflammatory bowel diseases&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;F&#46; Neurath"
                            1 => "S&#46;P&#46; Travis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/gutjnl-2012-302830"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gut"
                        "fecha" => "2012"
                        "volumen" => "61"
                        "paginaInicial" => "1619"
                        "paginaFinal" => "1635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22842618"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The potential for disease modification in Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Van Assche"
                            1 => "S&#46; Vermeire"
                            2 => "P&#46; Rutgeerts"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/nrgastro.2009.220"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nat Rev Gastroenterol Hepatol"
                        "fecha" => "2010"
                        "volumen" => "7"
                        "paginaInicial" => "79"
                        "paginaFinal" => "85"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20134489"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polymeric diet alone versus corticosteroids in the treatment of active pediatric Crohn&#39;s disease&#58; a randomized controlled open-label trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Borrelli"
                            1 => "L&#46; Cordischi"
                            2 => "M&#46; Cirulli"
                            3 => "M&#46; Paganelli"
                            4 => "V&#46; Labalestra"
                            5 => "S&#46; Uccini"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.cgh.2006.03.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Gastroenterol Hepatol"
                        "fecha" => "2006"
                        "volumen" => "4"
                        "paginaInicial" => "744"
                        "paginaFinal" => "753"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16682258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enteral nutrition and corticosteroids in the treatment of acute Crohn&#39;s disease in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;B&#46; Heuschkel"
                            1 => "C&#46;C&#46; Menache"
                            2 => "J&#46;T&#46; Megerian"
                            3 => "A&#46;E&#46; Baird"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2000"
                        "volumen" => "31"
                        "paginaInicial" => "8"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10896064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis&#58; enteral nutrition in active Crohn&#39;s disease in children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Dziechciarz"
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                            2 => "R&#46; Shamir"
                            3 => "H&#46; Szajewska"
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                      "doi" => "10.1111/j.1365-2036.2007.03431.x"
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                        "tituloSerie" => "Aliment Pharmacol Ther"
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                        "paginaInicial" => "795"
                        "paginaFinal" => "806"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17767463"
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                      "titulo" => "Enteral nutritional therapy for induction of remission in Crohn&#39;s disease"
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                          "autores" => array:3 [
                            0 => "M&#46; Zachos"
                            1 => "M&#46; Tondeur"
                            2 => "A&#46;M&#46; Griffiths"
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                    ]
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                        "tituloSerie" => "Cochrane Database Syst Rev"
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                        "paginaInicial" => "CD000542"
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                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0255"
              "etiqueta" => "11"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Exclusive enteral nutrition induces early clinical&#44; mucosal and transmural remission in paediatric Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
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                            1 => "R&#46; Muir"
                            2 => "P&#46; Lewindon"
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                        "tituloSerie" => "J Gastroenterol"
                        "fecha" => "2014"
                        "volumen" => "49"
                        "paginaInicial" => "638"
                        "paginaFinal" => "645"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23636735"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fecal calprotectin is a useful marker for disease activity in pediatric patients with inflammatory bowel disease"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "A&#46; Yoden"
                            2 => "K&#46; Matsumoto"
                            3 => "E&#46; Kimura"
                            4 => "K&#46; Inoue"
                            5 => "A&#46; Andoh"
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                    0 => array:2 [
                      "doi" => "10.1007/s10620-011-1633-y"
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                        "tituloSerie" => "Dig Dis Sci"
                        "fecha" => "2011"
                        "volumen" => "56"
                        "paginaInicial" => "2372"
                        "paginaFinal" => "2377"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21394462"
                            "web" => "Medline"
                          ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Crohn&#39;s disease activity assessed by fecal calprotectin and lactoferrin&#58; correlation with Crohn&#39;s disease activity index and endoscopic findings"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "E&#46; Savilahti"
                            2 => "K&#46;L&#46; Kolho"
                            3 => "H&#46; Nuutinen"
                            4 => "U&#46; Turunen"
                            5 => "M&#46; F&#228;rkkil&#228;"
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                    0 => array:2 [
                      "doi" => "10.1002/ibd.20312"
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                        "tituloSerie" => "Inflamm Bowel Dis"
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                        "volumen" => "14"
                        "paginaInicial" => "40"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18022866"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Relationships between disease activity and serum and fecal biomarkers in patients with Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "R&#46; Panaccione"
                            3 => "L&#46;S&#46; Chen"
                            4 => "S&#46; Peterson"
                            5 => "J&#46; McConnell"
                          ]
                        ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Clin Gastroenterol Hepatol"
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                        "paginaInicial" => "1218"
                        "paginaFinal" => "1224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18799360"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0735109704014457"
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                          "issn" => "07351097"
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                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "The utility of biomarkers in the diagnosis and therapy of inflammatory bowel disease"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;D&#46; Lewis"
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1053/j.gastro.2010.11.058"
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                        "tituloSerie" => "Gastroenterology"
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                        "volumen" => "140"
                        "paginaInicial" => "1817"
                        "paginaFinal" => "1826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21530748"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0280"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fecal calprotectin&#58; a quantitative marker of colonic inflammation in children with inflammatory bowel disease"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "U&#46;L&#46; Fagerberg"
                            1 => "L&#46; L&#246;&#246;f"
                            2 => "J&#46; Lindholm"
                            3 => "L&#46;O&#46; Hansson"
                            4 => "Y&#46; Finkel"
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                        ]
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                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "2007"
                        "volumen" => "45"
                        "paginaInicial" => "414"
                        "paginaFinal" => "420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18030206"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "U&#46;L&#46; Fagerberg"
                            1 => "L&#46; L&#246;&#246;f"
                            2 => "U&#46; Myrdal"
                            3 => "L&#46; Hansson"
                            4 => "Y&#46; Finkel"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
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                        "volumen" => "40"
                        "paginaInicial" => "450"
                        "paginaFinal" => "455"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15795593"
                            "web" => "Medline"
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                  ]
                ]
              ]
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              "identificador" => "bib0290"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inflammatory bowel disease in children and adolescents&#58; recommendations for diagnosis&#8212;the Porto criteria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
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                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
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                        "volumen" => "41"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15990620"
                            "web" => "Medline"
                          ]
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                      ]
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                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "Predicting basal metabolic rate&#44; new standards and review of previous work"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;N&#46; Schofield"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hum Nutr Clin Nutr"
                        "fecha" => "1985"
                        "volumen" => "39"
                        "paginaInicial" => "5"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4044297"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pediatric modification of the Montreal classification for inflammatory bowel disease&#58; the Paris classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Levine"
                            1 => "A&#46; Griffiths"
                            2 => "J&#46; Markowitz"
                            3 => "D&#46;C&#46; Wilson"
                            4 => "D&#46; Turner"
                            5 => "R&#46;K&#46; Russell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/ibd.21493"
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                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2011"
                        "volumen" => "17"
                        "paginaInicial" => "1314"
                        "paginaFinal" => "1321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21560194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0305"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development and validation of a pediatric Crohn&#39;s disease activity index"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;S&#46; Hyams"
                            1 => "G&#46;D&#46; Ferry"
                            2 => "F&#46;S&#46; Mandel"
                            3 => "J&#46;D&#46; Gryboski"
                            4 => "P&#46;M&#46; Kibort"
                            5 => "B&#46;S&#46; Kirschner"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "1991"
                        "volumen" => "12"
                        "paginaInicial" => "439"
                        "paginaFinal" => "447"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1678008"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0310"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Appraisal of the pediatric Crohn&#39;s disease activity index on four prospectively collected datasets&#58; recommended cutoff values and clinimetric properties"
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                        0 => array:2 [
                          "etal" => true
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                            2 => "T&#46;D&#46; Walters"
                            3 => "T&#46; Seah"
                            4 => "J&#46; Markowitz"
                            5 => "M&#46; Pfefferkorn"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Am J Gastroenterol"
                        "fecha" => "2010"
                        "volumen" => "105"
                        "paginaInicial" => "2085"
                        "paginaFinal" => "2092"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20372111"
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                  ]
                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudios espanoles de crecimiento"
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                        0 => array:2 [
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                            1 => "J&#46;M&#46; Fern&#225;ndez"
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                            3 => "J&#46;P&#46; L&#243;pez-Siguero"
                            4 => "D&#46; L&#243;pez"
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                  "host" => array:1 [
                    0 => array:1 [
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            23 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            2 => "O&#46; Borrelli"
                            3 => "M&#46;T&#46; Romano"
                            4 => "F&#46; Manguso"
                            5 => "A&#46; Coruzzo"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.dld.2005.10.005"
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                        "tituloSerie" => "Dig Liver Dis"
                        "fecha" => "2006"
                        "volumen" => "38"
                        "paginaInicial" => "381"
                        "paginaFinal" => "387"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16301010"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0325"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Polymeric nutrition as the primary therapy in children with small bowel Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "E&#46;J&#46; Schiffrin"
                            2 => "A&#46; Donnet-Hughes"
                            3 => "A&#46;C&#46; Huggett"
                            4 => "P&#46; Domizio"
                            5 => "T&#46;T&#46; MacDonald"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "1994"
                        "volumen" => "8"
                        "paginaInicial" => "609"
                        "paginaFinal" => "615"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7696450"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0330"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "M&#46; Paintin"
                            2 => "F&#46; Arnaud-Battandier"
                            3 => "R&#46;M&#46; Beattie"
                            4 => "A&#46; Hollis"
                            5 => "P&#46; Kitching"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Aliment Pharmacol Ther"
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                        "volumen" => "14"
                        "paginaInicial" => "281"
                        "paginaFinal" => "289"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10735920"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Use of exclusive enteral nutrition is just as effective as corticosteroids in newly diagnosed pediatric Crohn&#8217; disease"
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                          "etal" => true
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                            1 => "B&#46; Malik"
                            2 => "J&#46; Turner"
                            3 => "R&#46; Persad"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "I&#46;R&#46; Sanderson"
                            1 => "S&#46; Udeen"
                            2 => "P&#46;S&#46; Davies"
                            3 => "M&#46;O&#46; Savage"
                            4 => "J&#46;A&#46; Walker-Smith"
                          ]
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1987"
                        "volumen" => "62"
                        "paginaInicial" => "123"
                        "paginaFinal" => "127"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3548602"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Interventions for growth failure in childhood Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;A&#46; Newby"
                            1 => "A&#46; Sawczenko"
                            2 => "A&#46;G&#46; Thomas"
                            3 => "D&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Cochrane Database Syst Rev"
                        "fecha" => "2005"
                        "paginaInicial" => "CD003873"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0350"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Dietary intake and nutritional treatment in childhood Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;G&#46; Thomas"
                            1 => "F&#46; Taylor"
                            2 => "V&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr Gastroenterol Nutr"
                        "fecha" => "1993"
                        "volumen" => "17"
                        "paginaInicial" => "75"
                        "paginaFinal" => "81"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8350215"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "Development and validation of a new&#44; simplified endoscopic activity score for Crohn&#39;s disease&#58; the SESCD"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Daperno"
                            1 => "G&#46; D&#8217;Haens"
                            2 => "G&#46; Van Assche"
                            3 => "F&#46; Baert"
                            4 => "P&#46; Bulois"
                            5 => "V&#46; Maunoury"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "Revista" => array:6 [
                        "tituloSerie" => "Gastrointest Endosc"
                        "fecha" => "2004"
                        "volumen" => "60"
                        "paginaInicial" => "505"
                        "paginaFinal" => "512"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15472670"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Enteral nutrition in the management of Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;M&#46; Griffiths"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Parenter Enteral Nutr"
                        "fecha" => "2005"
                        "volumen" => "29"
                        "paginaInicial" => "S108"
                        "paginaFinal" => "S112"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0365"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Tratamiento general del brote de enfermedad de Crohn"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "V&#46;M&#46; Navas-L&#243;pez"
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                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Enfermedad inflamatoria intestinal en pediatr&#237;a"
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                        "paginaFinal" => "268"
                        "serieFecha" => "2012"
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0370"
              "etiqueta" => "34"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Treatment of active Crohn&#39;s disease in children using partial enteral nutrition with liquid formula&#58; a randomised controlled trial"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46; Johnson"
                            1 => "S&#46; Macdonald"
                            2 => "S&#46;M&#46; Hill"
                            3 => "A&#46; Thomas"
                            4 => "M&#46;S&#46; Murphy"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1136/gut.2004.062554"
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                        "tituloSerie" => "Gut"
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                        "volumen" => "55"
                        "paginaInicial" => "356"
                        "paginaFinal" => "361"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16162683"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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                    0 => array:2 [
                      "titulo" => "International survey of enteral nutrition protocols used in children with Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;E&#46; Whitten"
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                            2 => "C&#46;Y&#46; Ooi"
                            3 => "A&#46;S&#46; Day"
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                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1751-2980.2011.00558.x"
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                        "tituloSerie" => "J Dig Dis"
                        "fecha" => "2012"
                        "volumen" => "13"
                        "paginaInicial" => "107"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22257479"
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                          ]
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                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "The use of exclusive enteral nutrition for induction of remission in children with Crohn&#39;s disease demonstrates that disease phenotype does not influence clinical remission"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Buchanan"
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                            2 => "T&#46; Cardigan"
                            3 => "V&#46; Garrick"
                            4 => "P&#46; McGrogan"
                            5 => "R&#46;K&#46; Russell"
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                        ]
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                        "tituloSerie" => "Aliment Pharmacol Ther"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "501"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19549288"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Pediatric IBD collaborative research group&#46; Effect of early immunomodulator use in moderate to severe pediatric Crohn disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Punati"
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                            2 => "T&#46; Lerer"
                            3 => "J&#46; Hyams"
                            4 => "S&#46; Kugathasan"
                            5 => "A&#46; Griffiths"
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                        ]
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                    0 => array:2 [
                      "doi" => "10.1002/ibd.20412"
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                        "tituloSerie" => "Inflamm Bowel Dis"
                        "fecha" => "2008"
                        "volumen" => "14"
                        "paginaInicial" => "949"
                        "paginaFinal" => "954"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18306311"
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                          ]
                        ]
                      ]
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                  ]
                ]
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Early azathioprine therapy is no more effective than placebo for newly diagnosed Crohn&#39;s disease"
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                            5 => "Y&#46; Torres"
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                        "tituloSerie" => "Gastroenterology"
                        "fecha" => "2013"
                        "volumen" => "145"
                        "paginaInicial" => "766"
                        "paginaFinal" => "774"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23770132"
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                    0 => array:2 [
                      "titulo" => "Early administration of azathioprine versus conventional management of crohn&#39;s disease&#58; a randomized controlled trial"
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                        0 => array:2 [
                          "etal" => true
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                  ]
                ]
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                    0 => array:2 [
                      "titulo" => "A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn&#39;s disease"
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                        0 => array:2 [
                          "etal" => false
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                        "paginaFinal" => "902"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11040176"
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Article information

ISSN: 23412879
Original language: English

DOI:10.1016/j.anpede.2014.02.005

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2024 November	8	6	14
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2024 August	66	84	150
2024 July	50	30	80
2024 June	60	31	91
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2024 March	63	23	86
2024 February	54	29	83
2024 January	57	28	85
2023 December	62	22	84
2023 November	69	21	90
2023 October	53	37	90
2023 September	89	31	120
2023 August	86	27	113
2023 July	62	31	93
2023 June	64	34	98
2023 May	47	18	65
2023 April	49	21	70
2023 March	51	25	76
2023 February	59	18	77
2023 January	49	25	74
2022 December	65	35	100
2022 November	107	33	140
2022 October	60	38	98
2022 September	45	38	83
2022 August	66	47	113
2022 July	45	49	94
2022 June	54	57	111
2022 May	111	51	162
2022 April	53	45	98
2022 March	83	55	138
2022 February	82	38	120
2022 January	78	51	129
2021 December	75	33	108
2021 November	85	54	139
2021 October	100	68	168
2021 September	86	51	137
2021 August	95	45	140
2021 July	142	46	188
2021 June	55	43	98
2021 May	68	43	111
2021 April	253	53	306
2021 March	195	22	217
2021 February	46	22	68
2021 January	47	21	68
2020 December	74	29	103
2020 November	46	18	64
2020 October	42	26	68
2020 September	47	18	65
2020 August	35	13	48
2020 July	49	14	63
2020 June	93	14	107
2020 May	85	27	112
2020 April	109	26	135
2020 March	62	27	89
2020 February	61	30	91
2020 January	33	22	55
2019 December	61	35	96
2019 November	50	19	69
2019 October	80	13	93
2019 September	153	20	173
2019 August	221	27	248
2019 July	149	27	176
2019 June	168	19	187
2019 May	254	24	278
2019 April	277	57	334
2019 March	214	23	237
2019 February	262	30	292
2019 January	152	17	169
2018 December	65	34	99
2018 November	93	41	134
2018 October	112	30	142
2018 September	43	10	53
2018 August	3	0	3
2018 July	2	0	2
2018 June	3	0	3
2018 May	8	0	8
2018 April	27	0	27
2018 March	22	0	22
2018 February	32	0	32
2018 January	15	0	15
2017 December	37	0	37
2017 November	13	0	13
2017 October	17	0	17
2017 September	21	0	21
2017 August	18	0	18
2017 July	11	0	11
2017 June	28	10	38
2017 May	26	8	34
2017 April	25	11	36
2017 March	24	4	28
2017 February	20	4	24
2017 January	15	4	19
2016 December	50	9	59
2016 November	58	4	62
2016 October	76	6	82
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2016 August	67	4	71
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