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consiste en la administraci&#243;n de dieta exclusiva con f&#243;rmula enteral durante un per&#237;odo no inferior a 6&#8211;8 semanas&#46; Esta pauta ha demostrado ser efectiva para inducir la remisi&#243;n cl&#237;nica en ni&#241;os afectados de enfermedad de Crohn con tasas de respuesta cercanas al 80&#37;<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; La remisi&#243;n cl&#237;nica no siempre se asocia con la remisi&#243;n histol&#243;gica o con la curaci&#243;n de la mucosa&#46; La endoscopia digestiva con toma de biopsias y su posterior an&#225;lisis histol&#243;gico es la herramienta utilizada con patr&#243;n de referencia para conocer el grado de inflamaci&#243;n intestinal&#46; Es una t&#233;cnica invasiva y cara&#44; que precisa una preparaci&#243;n cuidadosa del colon y anestesia general para su realizaci&#243;n&#46; Las colonoscopias seriadas para comprobar la remisi&#243;n histol&#243;gica no est&#225;n al alcance de todos los centros sanitarios y suelen ser mal aceptadas por parte de los pacientes y de sus familiares&#46; En la actualidad se dispone de m&#233;todos de laboratorio que informan acerca del estado inflamatorio intestinal&#46; Entre ellos destacan la cuantificaci&#243;n en sangre&#47;heces de prote&#237;nas derivadas de los leucocitos &#40;prote&#237;na cati&#243;nica eosinof&#237;lica&#44; esterasa&#44; mieloperoxidasa&#44; lisozima&#44; lactoferrina o calprotectina&#41;&#46; Esta &#250;ltima es la prote&#237;na que m&#225;s abunda en el citoplasma del neutr&#243;filo y del macr&#243;fago&#44; es muy estable en las heces&#44; permanece inalterada durante m&#225;s de 7 d&#237;as&#44; permitiendo la conservaci&#243;n de las muestras hasta su env&#237;o y an&#225;lisis&#46; Es un marcador no invasivo&#44; con alta sensibilidad y especificidad&#44; que permite monitorizar la actividad inflamatoria en ni&#241;os y adultos&#44; y predecir la reca&#237;da cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Las concentraciones de calprotectina fecal est&#225;n estrechamente relacionadas con los hallazgos endosc&#243;picos e histol&#243;gicos&#46; Es un test de ELISA simple y econ&#243;mico&#44; que requiere una cantidad m&#237;nima de heces &#40;50&#8211;100 mg&#41; para su realizaci&#243;n&#46; Los valores aceptados como normales de calprotectina fecal en ni&#241;os mayores de 1 a&#241;o son de 50 &#956;g&#47;g de heces&#44; con una sensibilidad del 90 &#37; y una especificidad del 83 &#37; para correlacionarlos con procesos inflamatorios intestinales<a class="elsevierStyleCrossRefs" href="#bb0040"><span class="elsevierStyleSup">8&#8211;13</span></a>&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Los objetivos de nuestro estudio son los siguientes&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="o0005"><span class="elsevierStyleLabel">1&#46;</span><p id="p0020" class="elsevierStylePara elsevierViewall">Determinar la eficacia del TNP para inducir la remisi&#243;n cl&#237;nica en el primer brote de enfermedad de Crohn en ni&#241;os&#46;</p></li><li class="elsevierStyleListItem" id="o0010"><span class="elsevierStyleLabel">2&#46;</span><p id="p0025" class="elsevierStylePara elsevierViewall">Determinar la eficacia del TNP para mejorar el grado de inflamaci&#243;n de la mucosa intestinal utilizando como marcador la calprotectina fecal&#46;</p></li><li class="elsevierStyleListItem" id="o0015"><span class="elsevierStyleLabel">3&#46;</span><p id="p0030" class="elsevierStylePara elsevierViewall">Estimar la tasa de cumplimiento del TNP&#46;</p></li></ul></p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">PACIENTES Y M&#201;TODOS</span><p id="p0035" class="elsevierStylePara elsevierViewall">En este estudio prospectivo observacional se incluyeron todos los pacientes menores de 14 a&#241;os diagnosticados de enfermedad de Crohn atendiendo a criterios cl&#237;nicos&#44; radiol&#243;gicos&#44; endosc&#243;picos y anatomopatol&#243;gicos entre enero de 2002 y octubre de 2007&#44; y que recibieron alimentaci&#243;n exclusiva con f&#243;rmula polim&#233;rica &#40;Modulen IBD&#44; Nestl&#233;&#44; Vevey&#44; Suiza&#41; durante el primer brote de su enfermedad&#46; Quedaron excluidos los pacientes diagnosticados de colitis ulcerosa&#44; colitis indeterminada&#44; colitis eosinof&#237;lica o colitis infecciosa&#44; as&#237; como los diagnosticados de enfermedad de Crohn que recibieron tratamiento concomitante o previo con corticoides y&#47;o f&#225;rmacos inmunosupresores &#40;azatioprina&#44; 6-mercaptopurina&#44; entre otros&#41;&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Modulen IBD se prepar&#243; mezclando 1&#46;700 ml de agua con 400 g de producto&#44; lo que daba lugar a 2&#46;000 ml de una f&#243;rmula normocal&#243;rica &#40;1 kcal&#47;ml&#41;&#46; El c&#225;lculo de las necesidades energ&#233;ticas se estim&#243; mediante la f&#243;rmula de Schofield&#46; La pauta de administraci&#243;n fue de 4&#8211;5 tomas al d&#237;a&#44; y s&#243;lo se permit&#237;a la ingesti&#243;n de agua durante el tratamiento&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Los datos recogidos fueron edad&#44; sexo&#44; antecedentes familiares de enfermedad inflamatoria intestinal cr&#243;nica &#40;EIIC&#41;&#44; tiempo transcurrido hasta el diagn&#243;stico y tratamiento farmacol&#243;gico asociado &#40;5-aminosalicilatos &#91;5-ASA&#93; y&#47;o metronidazol&#41;&#46; El fenotipo de la enfermedad de Crohn se estableci&#243; atendiendo a la clasificaci&#243;n de Montreal &#40;<a class="elsevierStyleCrossRef" href="#t0005">tabla 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0050" class="elsevierStylePara elsevierViewall">Todos los pacientes fueron valorados al inicio del tratamiento&#44; a las 4 semanas y al final de la octava semana de tratamiento&#46; En estos tres controles se recogieron los siguientes datos&#58; peso&#44; talla&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; calprotectina fecal &#40;Calprest&#44; Eurospital&#44; Italia&#41; y se determin&#243; el &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica &#40;PCDAI&#41;<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#t0010">tabla 2</a>&#41;&#46; La remisi&#243;n cl&#237;nica se defini&#243; cuando el PCDAI era igual o inferior a 10&#46; Se consideraron como normales valores de calprotectina fecal inferiores a 50 &#956;g&#47;g de heces&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">An&#225;lisis estad&#237;stico</span><p id="p0055" class="elsevierStylePara elsevierViewall">Utilizamos el programa estad&#237;stico SPSS versi&#243;n 13&#46;0&#46; El contraste de muestras apareadas se realiz&#243; con el contraste de Wilcoxon&#46; El coeficiente de correlaci&#243;n entre las variables se estableci&#243; con el coeficiente de Spearman&#46; Se consider&#243; un valor de p &#60; 0&#44;05 como estad&#237;sticamente significativo&#46;</p></span></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">RESULTADOS</span><p id="p0060" class="elsevierStylePara elsevierViewall">Se incluy&#243; un total de 14 pacientes &#40;9 varones&#41;&#44; con una edad media en el momento del diagn&#243;stico de 10&#44;74 &#177; 2&#44;56 a&#241;os&#46; S&#243;lo 2 pacientes ten&#237;an antecedentes familiares de EIIC &#40;uno de colitis ulcerosa y otro de enfermedad de Crohn&#41;&#46; El tiempo medio transcurrido desde el inicio de los s&#237;ntomas hasta la confirmaci&#243;n diagn&#243;stica fue de 104&#44;72 &#177; 52&#44;7 d&#237;as&#46; El fenotipo m&#225;s frecuente fue L3B1A1 &#40;50 &#37;&#41;&#44; seguido de L3-L4B1A1 &#40;21&#44;4 &#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#41;&#46; La afectaci&#243;n perianal se observ&#243; en 3 pacientes &#40;21&#44;4 &#37;&#41;&#46; En todos los casos el patr&#243;n cl&#237;nico fue inflamatorio&#46; Modulen IBD fue bien tolerado&#44; ning&#250;n paciente requiri&#243; sonda nasog&#225;strica para su administraci&#243;n y ninguno abandon&#243; la dieta antes de las 8 semanas&#46; Todos recibieron aminosalicilatos &#40;50&#8211;100 mg&#47;kg&#47;d&#237;a&#41; y cuatro de ellos&#44; adem&#225;s&#44; metronidazol &#40;20&#8211;30 mg&#47;kg&#47;d&#237;a&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0065" class="elsevierStylePara elsevierViewall">Al inicio del TNP&#44; el peso fue de 37&#44;03 &#177; 11&#44;29 kg&#44; el PCDAI de 30&#44;17 &#177; 11&#44;15 y los valores de calprotectina fecal de 512 &#177; 235 &#956;g&#47;g heces&#46; A las 4 semanas&#44; el 71&#37; de los pacientes &#40;10 de 14 casos&#41; hab&#237;a alcanzado la remisi&#243;n cl&#237;nica &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41;&#44; que se acompa&#241;&#243; de un descenso no significativo de las cifras de calprotectina fecal &#40;p &#61; 0&#44;221&#41;&#46; A las 8 semanas&#44; el 85 &#37; de los pacientes estaba en remisi&#243;n cl&#237;nica &#40;p &#61; 0&#44;001&#41; y la excreci&#243;n fecal de calprotectina hab&#237;a experimentado un descenso significativo &#40;p &#61; 0&#44;03&#41;&#44; sin alcanzar en ning&#250;n momento valores normales &#40;<a class="elsevierStyleCrossRef" href="#f0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0070" class="elsevierStylePara elsevierViewall">Se observ&#243; un incremento de peso y talla al final del TNP &#40;<a class="elsevierStyleCrossRef" href="#t0020">tabla 4</a>&#41;&#46; El coeficiente de Spearman entre el PCDAI y la calprotectina fecal de nuestra muestra fue de 0&#44;449 &#40;p &#61; 0&#44;003&#41;&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">DISCUSI&#211;N</span><p id="p0075" class="elsevierStylePara elsevierViewall">Los mecanismos de acci&#243;n de la nutrici&#243;n enteral sobre la inflamaci&#243;n intestinal en la enfermedad de Crohn se desconocen&#59; entre las hip&#243;tesis se incluyen la modificaci&#243;n en la flora intestinal&#44; la eliminaci&#243;n de la captaci&#243;n de ant&#237;genos alimentarios&#44; la disminuci&#243;n de la s&#237;ntesis intestinal de mediadores inflamatorios a causa de una reducci&#243;n de la grasa en la dieta o el aporte de micronutrientes al intestino enfermo<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a>&#46; Numerosos ensayos realizados en adultos y en ni&#241;os ponen de manifiesto que no existen diferencias en la tasa de remisi&#243;n ni en el cumplimiento del tratamiento nutricional en relaci&#243;n con la f&#243;rmula enteral empleada &#40;polim&#233;rica&#44; semielemental o elemental&#41;<a class="elsevierStyleCrossRefs" href="#bb0085"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46; Tampoco se han demostrado ventajas con suplementos en glutamina ni con triglic&#233;ridos de cadena media<a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall">Actualmente no existen datos que demuestren la eficacia de los aminosalicilatos &#40;5-ASA&#41; en la inducci&#243;n a la remisi&#243;n en ni&#241;os con enfermedad de Crohn&#46; S&#237; se han referido datos en adultos&#59; en un metaan&#225;lisis llevado a cabo en 600 pacientes adultos con enfermedad de Crohn<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> se ha puesto de manifiesto un descenso significativo del CDAI de 63 puntos en los pacientes tratados con 5-ASA frente a 45 puntos en los que recibieron placebo&#46; Esta diferencia de 18 puntos&#44; pese a ser significativa&#44; carece de relevancia cl&#237;nica&#46; En cuanto al empleo de metronidazol&#44; un estudio controlado con placebo en la enfermedad de Crohn activa no demostr&#243; la existencia de diferencias significativas con respecto al placebo&#44; tras 16 semanas de tratamiento<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a>&#46; Estos argumentos apoyan que el tratamiento coadyuvante con 5-ASA y&#47;o metronidazol en nuestra muestra no haya influido en la tasa final de remisi&#243;n&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#t0025">tabla 5</a> se exponen los datos de los estudios realizados en ni&#241;os &#40;duraci&#243;n&#44; tipo de f&#243;rmula&#44; criterios para definir la remisi&#243;n cl&#237;nica y tasa de remisi&#243;n&#41;&#46;</p><elsevierMultimedia ident="t0025"></elsevierMultimedia><p id="p0090" class="elsevierStylePara elsevierViewall">Ludvigsson et al<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> incluyeron a 31 pacientes menores de 17 a&#241;os diagnosticados de enfermedad de Crohn&#59; 16 recibieron f&#243;rmula elemental &#40;Elemental 028&#44; SHS&#44; Reino Unido&#41; y 17&#44; f&#243;rmula polim&#233;rica &#40;Nutrison Standard&#44; Nutricia&#44; Pa&#237;ses Bajos&#41;&#44; durante 6 semanas&#46; Se encontr&#243; una tasa de remisi&#243;n del 69 &#37; para los pacientes que tomaban f&#243;rmula elemental frente al 82 &#37; de los que tomaron f&#243;rmula polim&#233;rica &#40;p &#61; NS&#41;&#46; Fell et al<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> administraron Modulen IBD a 29 pacientes &#40;17 en primer brote y 12 en reca&#237;da&#41; durante 8 semanas&#59; el 79 &#37; se encontraba en remisi&#243;n cl&#237;nica al final de este per&#237;odo&#46; Day et al<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> seleccionaron a 27 pacientes &#40;15 en primer brote y 12 en reca&#237;da&#41;&#59; todos recibieron f&#243;rmula polim&#233;rica durante 6&#8211;8 semanas&#44; bien Modulen IBD &#40;Nestl&#233;&#44; Sidney&#44; NSW&#44; Australia&#41; u Osmolite &#40;Abbott Nutrition Internacional&#44; Botany&#44; NSW&#44; Australia&#41;&#46; La tasa global de remisi&#243;n&#44; por protocolo&#44; fue del 79&#37; &#40;del 80 &#37; en los nuevos pacientes y del 58 &#37; en los pacientes en reca&#237;da&#41;&#46; Borrelli et al<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&#44; en un estudio prospectivo y aleatorizado que comparaba la eficacia de la f&#243;rmula polim&#233;rica &#40;Modulen IBD&#41; frente a los corticoides para inducir la remisi&#243;n cl&#237;nica&#44; endosc&#243;pica e histol&#243;gica en una muestra de 19 pacientes con nuevo diagn&#243;stico de enfermedad de Crohn&#44; encontraron que al final de las 10 semanas de tratamiento nutricional el 79 &#37; de los pacientes se encontraban en remisi&#243;n cl&#237;nica&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">Sanderson et al<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> administraron por sonda nasog&#225;strica a 9 pacientes una dieta elemental &#40;Flexical&#41; durante 6 semanas&#44; al final de las cuales se encontraba en remisi&#243;n el 89 &#37; de los pacientes&#46; Ruuska et al<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> obtuvieron tambi&#233;n esta tasa de remisiones tras administrar a 10 ni&#241;os Nutrison Standard &#40;Nutricia&#41; durante 8 semanas&#46; Thomas et al<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> utilizaron Elemental 028 en 12 ni&#241;os durante 4 semanas&#44; con una respuesta cl&#237;nica excelente&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">Johnson et al<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> compararon dos modalidades distintas de tratamiento nutricional en un grupo de 50 pacientes diagnosticados de enfermedad de Crohn&#46; Emplearon la f&#243;rmula Elemental 028 Extra &#40;SHS&#44; International&#41; en todos los pacientes durante 6 semanas&#59; 26 de ellos recibieron la mitad de sus necesidades cal&#243;ricas diarias en forma de f&#243;rmula elemental y el resto mediante dieta normal &#40;modalidad nutrici&#243;n enteral parcial&#44; NEP&#41;&#46; Por otro lado&#44; 24 pacientes recibieron todas sus necesidades cal&#243;ricas en forma de f&#243;rmula elemental &#40;modalidad nutrici&#243;n enteral total&#44; NET&#41;&#46; Al final de las 6 semanas&#44; el 62 &#37; de los pacientes con NET frente al 25 &#37; de los que recib&#237;an NEP se encontraban en remisi&#243;n cl&#237;nica&#46; Afzal et al<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a> administraron una f&#243;rmula polim&#233;rica &#40;ACD004&#44; Nestl&#233;&#41; similar a Modulen IBD pero con diferente composici&#243;n grasa durante 8 semanas&#44; sin permitir otros alimentos a 26 pacientes&#44; alcanzando el 85 &#37; de ellos la remisi&#243;n cl&#237;nica al final del tratamiento&#46; Akobeng et al<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a> dividieron en dos grupos a 18 pacientes con enfermedad de Crohn&#59; a nueve de ellos les administraron una f&#243;rmula polim&#233;rica con bajo contenido en glutamina y al resto una f&#243;rmula polim&#233;rica enriquecida en glutamina&#46; No se encontraron diferencias significativas en la tasa de remisi&#243;n entre ambos grupos y al final de las 4 semanas de tratamiento el 56&#37; hab&#237;a alcanzado la remisi&#243;n cl&#237;nica&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">Terrin et al<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> administraron alimentaci&#243;n exclusiva con f&#243;rmula semielemental &#40;Pregomin&#44; Milupa&#41; durante 8 semanas a un grupo de 10 pacientes&#59; el 90 &#37; alcanz&#243; la remisi&#243;n cl&#237;nica&#46; Papadopoulou et al<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> encontraron una tasa de remisi&#243;n del 83 &#37; en un grupo de 19 pacientes tratados con dieta elemental &#40;E028&#44; SHS&#44; Liverpool&#44; Reino Unido&#41; durante 6 semanas&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">Beattie et al<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> utilizaron una dieta polim&#233;rica enriquecida con TGF-&#946; en 7 pacientes menores de 18 a&#241;os durante 8 semanas&#44; al final de las cuales observaron una mejor&#237;a cl&#237;nica muy significativa en todos los pacientes&#44; junto con una aceptable ganancia ponderal y una normalizaci&#243;n de los valores de prote&#237;na C reactiva &#40;PCR&#41; y de alb&#250;mina plasm&#225;ticas&#46; Rodrigues et al<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a> dividieron a 98 ni&#241;os con enfermedad de Crohn en su primer brote de enfermedad en dos grupos para recibir una f&#243;rmula polim&#233;rica &#40;Clinutren&#44; Nestl&#233; Clinical Nutrition&#44; Deerfield&#44; IL&#44; EE&#46;UU&#46;&#41;&#44; Fortisip &#40;Nutricia&#44; Trowbridge&#44; Reino Unido&#41; o Ensure plus &#40;Abbott Laboratories&#44; Chicago&#44; IL&#44; EE&#46;UU&#46;&#41; o una elemental &#40;Elemental 028 o Elemental 028 Extra &#91;SHS International&#44; Liverpool&#44; Reino Unido&#93;&#41; durante 6 semanas&#46; Las tasas de remisi&#243;n fueron del 51 y del 64 &#37; &#40;p &#61; 0&#44;19&#41;&#44; respectivamente&#46; Knight et al<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> publicaron los datos de 44 ni&#241;os que hab&#237;an recibido durante 6 semanas bien Elemental 028 &#40;SHS International Limited&#44; Liverpool&#44; Reino Unido&#41; o bien Ensure Plus &#40;Abbott Laboratories Limited&#44; Maidenhead&#44; Reino Unido&#41;&#46; La tasa de remisi&#243;n global fue del 90 &#37;&#46; Berni Canani et al<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> emplearon Modulen IBD en 12 pacientes&#44; Pregomin en 13 casos y f&#243;rmula elemental &#40;Neocate&#44; Nutricia&#44; Italia&#41; en 12 pacientes&#46; El 86&#44;5 &#37; alcanz&#243; la remisi&#243;n al final de las 8 semanas&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">Analizando los datos expuestos en la <a class="elsevierStyleCrossRef" href="#t0025">tabla 5</a>&#44; la tasa global de remisi&#243;n&#44; por intenci&#243;n de tratar&#44; fue del 76&#44;5 &#37;&#44; y por protocolo&#44; del 84&#44;4 &#37;&#44; con una tasa de cumplimiento del 90 &#37;&#46; Si agrupamos los estudios de 8 semanas de duraci&#243;n y con el criterio de remisi&#243;n cl&#237;nica de PCDAI inferior a 10 y los comparamos con nuestra serie&#44; los resultados son similares &#40;tasa de remisi&#243;n por protocolo del 90&#44;3&#37; frente al 85 &#37; y por intenci&#243;n de tratar del 86&#44;5 &#37; frente al 85 &#37;&#59; cumplimiento del 98&#44;25&#37; frente al 100 &#37;&#41;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0140"><span class="elsevierStyleSup">28&#44;29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&#46; Para asegurar el cumplimiento terap&#233;utico es importante explicarles a los pacientes y a sus familiares el objetivo y la duraci&#243;n del tratamiento&#44; as&#237; como las alternativas de las que se dispone para su administraci&#243;n en caso de falta de tolerancia oral&#46; La diferencia apreciada entre los distintos estudios puede deberse al tama&#241;o de la muestra&#44; a los distintos criterios de remisi&#243;n empleados y a la f&#243;rmula administrada&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">El objetivo principal en el tratamiento de la enfermedad de Crohn es la remisi&#243;n histol&#243;gica o la curaci&#243;n de la mucosa&#46; En relaci&#243;n con este aspecto&#44; existen varios trabajos que eval&#250;an de una u otra forma la mejor&#237;acuraci&#243;n de la mucosa intestinal&#46; En este sentido&#44; Fell et al<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> repitieron la colonoscopia a 26 pacientes al finalizar las 8 semanas de TNP y encontraron una mejor&#237;a en el 50 &#37; de los casos y curaci&#243;n en el 30 &#37;&#46; Cuando analizaron los hallazgos del &#237;leon terminal&#44; el 68 &#37; hab&#237;a mejorado y se hab&#237;a curado el 53 &#37;&#46; El an&#225;lisis histol&#243;gico puso de manifiesto una mejor&#237;a en el 48 &#37; de las biopsias col&#243;nicas &#40;curaci&#243;n histol&#243;gica en el 8 &#37;&#41; y en el 65 &#37; de las de &#237;leon terminal &#40;curaci&#243;n histol&#243;gica en el 40 &#37;&#41;&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">Borrelli et al<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&#44; tras las 10 semanas de nutrici&#243;n enteral con f&#243;rmula polim&#233;rica&#44; observaron una mejor&#237;a significativa en los &#237;ndices endosc&#243;picos e histol&#243;gicos&#44; tanto en el &#237;leon terminal como en el colon&#46; Tambi&#233;n Berni Canani et al<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> constataron una mejor&#237;a significativa en los &#237;ndices histol&#243;gicos y endosc&#243;picos de los pacientes sometidos a TNP&#44; independientemente de la f&#243;rmula utilizada&#46; Beattie et al<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a>&#44; tras el an&#225;lisis de las muestras obtenidas despu&#233;s de 8 semanas de tratamiento&#44; demostraron una mejor&#237;a histol&#243;gica en el 85 &#37; de los casos &#40;6 de 7 casos&#41;&#44; y dos de ellos alcanzaron la remisi&#243;n histol&#243;gica&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">En nuestra serie encontramos una disminuci&#243;n de los valores de calprotectina fecal al final de las 8 semanas en el 71 &#37; de los pacientes&#44; lo que puede interpretarse como una mejor&#237;a del grado de inflamaci&#243;n intestinal&#44; y en ning&#250;n caso se alcanzaron valores inferiores a 50 &#956;g&#47;g de heces&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">Exist&#237;a una idea inicial de que el tratamiento nutricional era m&#225;s efectivo en pacientes con afectaci&#243;n ileal que en los que presentaban una enfermedad de localizaci&#243;n exclusivamente col&#243;nica&#46; En la actualidad no existen datos que permitan establecer una correlaci&#243;n entre la respuesta al TNP y el fenotipo de la enfermedad&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">Uno de los aspectos m&#225;s debatidos en las &#250;ltimas dos d&#233;cadas es la eficacia del tratamiento nutricional frente a los esteroideos para inducir la remisi&#243;n en pacientes afectados de enfermedad de Crohn&#46; Trabajos realizados en ni&#241;os como los de Sanderson et al<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> o de Thomas et al<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> ya pon&#237;an de manifiesto hace 15&#8211;20 a&#241;os que la efectividad de los corticoides para inducir la remisi&#243;n era similar a la de la nutrici&#243;n enteral&#46; Esos datos no se reflejaban en los estudios llevados a cabo en adultos ni en los tres metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0190"><span class="elsevierStyleSup">38&#44;39</span></a> que analizaban conjuntamente resultados de series pedi&#225;tricas y de adultos&#44; en los que se observaba mayor eficacia con el tratamiento esteroideo&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">Dos metaan&#225;lisis de ensayos pedi&#225;tricos llegan a la conclusi&#243;n de que el tratamiento nutricional en la enfermedad de Crohn pedi&#225;trica es tan eficaz como los corticoides en la inducci&#243;n de la remisi&#243;n de la enfermedad&#44; pero sin sus efectos delet&#233;reos<a class="elsevierStyleCrossRefs" href="#bb0200"><span class="elsevierStyleSup">40&#44;41</span></a>&#46; Tambi&#233;n dos estudios recientes han comprobado que el tratamiento nutricional es m&#225;s eficaz que los esteroides para mejorar la inflamaci&#243;n intestinal&#44; recuperar el crecimiento y mantener la remisi&#243;n cl&#237;nica<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el TNP ha demostrado ser efectivo en la inducci&#243;n a la remisi&#243;n cl&#237;nica e histol&#243;gica en ni&#241;os con enfermedad de Crohn&#44; independientemente del fenotipo&#46; En general es bien tolerado y su eficacia para inducir la remisi&#243;n cl&#237;nica es similar a la de los esteroides&#44; pero sin sus efectos secundarios&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">La correlaci&#243;n entre PCDAI y calprotectina fecal es baja&#44; y se necesitan las dos herramientas para el seguimiento de los pacientes&#46; Una explicaci&#243;n detallada del plan de tratamiento al paciente y a sus familiares puede desembocar en el &#233;xito del cumplimiento del TNP&#46; Debemos informar a nuestros pacientes de la posibilidad del uso de sonda nasog&#225;strica y dejar a su elecci&#243;n la v&#237;a de administraci&#243;n de la f&#243;rmula polim&#233;rica&#46; Debido al corto per&#237;odo de tiempo en el que se ha de administrar el TNP no creemos indicada la realizaci&#243;n de una gastrostom&#237;a&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">El TNP administrado durante un per&#237;odo de 8 semanas puede inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n de la mucosa intestinal&#44; lo que se refleja en la disminuci&#243;n de las cifras de calprotectina fecal&#46;</p></span></span>"
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    "fechaRecibido" => "2008-06-30"
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            0 => "Enfermedad de Crohn"
            1 => "Enfermedad inflamatoria intestinal"
            2 => "Tratamiento nutricional"
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            0 => "Crohn&#39;s disease"
            1 => "Inflammatory bowel disease"
            2 => "Nutritional therapy"
            3 => "Calprotectin"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">El tratamiento nutricional primario &#40;TNP&#41;&#44; que consiste en la administraci&#243;n de dieta exclusiva con f&#243;rmula enteral &#40;polim&#233;rica&#44; semielemental o elemental&#41; durante un per&#237;odo no inferior a 6-8 semanas&#44; ha demostrado ser efectivo para inducir la remisi&#243;n cl&#237;nica en ni&#241;os afectados de enfermedad de Crohn&#46; La remisi&#243;n cl&#237;nica no siempre conlleva la remisi&#243;n histol&#243;gica o la curaci&#243;n de la mucosa&#46; La calprotectina fecal es un excelente marcador de la actividad inflamatoria intestinal y sus concentraciones se correlacionan estrechamente con el grado de inflamaci&#243;n de la mucosa intestinal&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio prospectivo observacional en el que se incluyeron todos los pacientes menores de 14 a&#241;os diagnosticados de enfermedad de Crohn entre enero de 2002 y octubre de 2007 que recibieron alimentaci&#243;n exclusiva con f&#243;rmula polim&#233;rica &#40;Modulen IBD&#44; Nestl&#233;&#44; Vevey&#44; Suiza&#41; durante su primer brote de enfermedad&#46; Se establecieron controles cl&#237;nicos &#40;peso&#44; talla&#44; &#237;ndice de masa corporal&#44; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica &#91;PCDAI&#93;&#41; y determinaciones de calprotectina fecal al inicio&#44; y a las 4 y 8 semanas de tratamiento&#46; La remisi&#243;n cl&#237;nica se defini&#243; cuando el PCDAI era igual o inferior a 10&#46; Se consideraron normales valores de calprotectina fecal inferiores a 50 &#956;g&#47;g de heces&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="sp0085" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 14 pacientes &#40;9 varones&#41;&#44; con una edad media en el momento del diagn&#243;stico de 10&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;56 a&#241;os&#46; A las 4 semanas&#44; el 71 &#37; de los pacientes alcanzaron la remission cl&#237;nica&#44; que se acompa&#241;&#243; de un descenso no significativo de las cifras de calprotectina fecal&#46; A las 8 semanas&#44; el 85 &#37; de los pacientes logr&#243; la remisi&#243;n cl&#237;nica y los valores de calprotectina fecal hab&#237;an descendido de forma significativa&#44; aunque sin alcanzar concentraciones normales&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="sp0090" class="elsevierStyleSimplePara elsevierViewall">El TNP administrado durante un per&#237;odo de 8 semanas puede inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n de la mucosa intestinal&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="sp0095" class="elsevierStyleSimplePara elsevierViewall">The primary nutritional therapy &#40;PNT&#41;&#44; which consists in the administration of exclusive enteral formula feeds &#40;polymeric&#44; semi-elemental or elemental formula&#41; for a period of no less than 6-8 weeks&#44; has proven to be effective in inducing clinical remission in children with Crohn&#39;s disease&#46; The clinical remission does not always include histological remission or cure of the mucosa&#46; Faecal calprotectin is closely correlated with endoscopic and histological findings but is slightly associated with clinical activity scores&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="sp0100" class="elsevierStyleSimplePara elsevierViewall">An observational prospective study including all patients under 14 years of age diagnosed with Crohn&#39;s disease between January 2002 and October 2007&#44; and who were fed exclusively with polymeric formula &#40;Modulen IBD&#44; Nestle&#44; Vevey&#44; Switzerland&#41; during the onset of the disease&#46; Clinical controls were carried out &#40;weight&#44; height&#44; body mass index &#91;BMI&#41; and the Paediatric Crohn&#39;s Disease Activity Index &#91;PCDAI&#41;&#41; and faecal calprotectin was measured at the beginning and at weeks 4 and 8 of treatment&#46; The clinical remission was defined as having a PCDAI less than or equal to 10&#46; Faecal calprotectin values below 50 &#956;g&#47;g faeces were considered as normal&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="sp0105" class="elsevierStyleSimplePara elsevierViewall">There were 14 patients &#40;9 males&#41;&#44; mean age at diagnosis of 10&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;56 years&#46; At week 4&#44; 71 &#37; of patients &#40;10&#47;14&#41; had achieved clinical remission and a decrease in faecal calprotectin levels that was not significant&#46; After 8 weeks&#44; 85 &#37; of our patients were in clinical remission and faecal calprotectin values had declined significantly without reaching normal levels&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="sp0110" class="elsevierStyleSimplePara elsevierViewall">Primary nutritional therapy administered over a period of 8 weeks is capable of inducing clinical remission and improving the degree of inflammation of the intestinal mucosa&#46;</p>"
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                  \t\t\t\t">L3 &#43; L4 &#40;ileoc&#243;lica &#43; tracto digestivo alto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tracto digestivo alto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Patr&#243;n cl&#237;nico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#40;B&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflamatorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B1p &#40;inflamatorio con afecci&#243;n perianal asociada&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estenosante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B2p &#40;estenosante con afecci&#243;n perianal asociada&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fistulizante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B3p &#40;fistulizante con afecci&#243;n perianal asociada&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Puntuaci&#243;n total &#40;0 a 100&#41;&#58; PCDAI &#8805; 30&#58; enfermedad moderada o grave&#59; PCDAI &#62; 11 e &#60; 30&#58; enfermedad leve&#59; PCDAI &#8804; 10&#58; remisi&#243;n cl&#237;nica&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; PCDAI&#58; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica&#46;</p>"
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                  \t\t\t\t"></td><td class="td" title="\n
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                  \t\t\t\t">Puntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Leve&#44; de corta duraci&#243;n&#44; no interfiere con la actividad normal</td><td class="td" title="\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Intenso&#44; de larga duraci&#243;n&#44; afecta a la actividad normal&#44; nocturno</td><td class="td" title="\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Deposiciones &#40;por d&#237;a&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0-1 deposiciones l&#237;quidas&#44; con ausencia de sangre</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Hasta 2 deposiciones semiblandas con sangre o 2&#8211;5 deposiciones l&#237;quidas</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Sangrado abundante o &#62; 6 deposiciones l&#237;quidas o diarrea nocturna</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado general y capacidad funcional</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regular&#46; Dificultades ocasionales para mantener las actividades habituales</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46; Anal&#237;tica</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Velocidad de sedimentaci&#243;n globular &#40;mm&#47;h&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 20</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20-50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Alb&#250;mina &#40;g&#47;l&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 35</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31-34</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 30</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematocrito &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; <span class="elsevierStyleItalic">10 anos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Var&#243;n 11-14 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Var&#243;n 15&#8211;19 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mujer 11&#8211;19 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#8211;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#8211;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#8211;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#8211;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">3&#46; Exploraci&#243;n</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Peso</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento de peso&#44; peso estable voluntario o adelgazamiento</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peso estable involuntario&#44; adelgazamiento del 1 al 9 &#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adelgazamiento &#62; 10 &#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Abdomen</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No se observan masas abdominales ni dolor con la palpaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor con la palpaci&#243;n o masas abdominales sin dolor con la palpaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor con la palpaci&#243;n&#44; contractura abdominal o masa abdominal definida</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Talla &#40;completar s&#243;lo en el momento del diagn&#243;stico&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n de menos de 1 escala &#40;1 escala &#61; 2 percentiles&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n de 1 a 2 escalas</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n de m&#225;s de 2 escalas</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Talla &#40;completar s&#243;lo durante el seguimiento&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Velocidad de crecimiento &#62; &#8212;1 DE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Velocidad de crecimiento &#60; &#8212;1 DE o &#62; &#8212;2 DE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Velocidad de crecimiento &#62; &#8212;2 DE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad perirrectal</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de colgajos o papilomas cut&#225;neos asintom&#225;ticos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-2 f&#237;stulas indoloras&#44; drenaje&#44; sin dolor con la palpaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#237;stulas activas&#44; drenaje&#44; dolor con la palpaci&#243;n o absceso</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manifestaciones extraintestinales</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 o m&#225;s</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">&#205;ndice de actividad de la enfermedad de Crohn en ni&#241;os &#40;PCDAI&#41;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a></p>"
        ]
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          "leyenda" => "<p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">CF&#58; calprotectina fecal &#40;a las 0&#44; 4 y 8 semanas de tratamiento&#41;&#59; PCDAI&#58; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fenotipo<a class="elsevierStyleCrossRef" href="#tf0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CF 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CF 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CF 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 a&#241;os y 8 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3B1A1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">245&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">358&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">R<a class="elsevierStyleCrossRef" href="#tf0025">&#42;&#42;</a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Sanderson &#40;1987&#41;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mejor&#237;a DAIS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ruuska &#40;1993&#41;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Thomas &#40;1993&#41;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DAIS &#62; 80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Papadopoulou &#40;1995&#41;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DAIS &#62; 80 &#43; ausencia de s&#237;ntomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Akobeng &#40;2000&#41;<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Fell &#40;2000&#41;<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Terrin &#40;2002&#41;<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Semielemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Ludvigsson &#40;2004&#41;<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">PCDAI &#60; 10 o &#8595; 45 &#37; o &#8595; 15 puntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">PCDAI &#60; 10 o &#8595; 45 &#37; o &#8595; 15 puntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Afzal &#40;2004&#41;<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PCDAI &#60; 20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Knight &#40;2005&#41;<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">CDAI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Day &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">PCDAI &#60; 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Borrelli &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Johnson &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Berni Canani &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semielemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodrigues &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No especificados<a class="elsevierStyleCrossRef" href="#tf0030">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No especificados<a class="elsevierStyleCrossRef" href="#tf0030">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Navas &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "identificador" => "tf0020"
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              "nota" => "<p class="elsevierStyleNotepara" id="np0025">an&#225;lisis por intenci&#243;n de tratar&#59;</p>"
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              "identificador" => "tf0030"
              "etiqueta" => "&#42;&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="np0030">informaci&#243;n obtenida del autor&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">Tasa de remisi&#243;n cl&#237;nica en ni&#241;os con enfermedad de Crohn y tratamiento nutricional primario</p>"
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    "bibliografia" => array:2 [
      "titulo" => "BIBLIOGRAF&#205;A"
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        0 => array:2 [
          "identificador" => "bs0005"
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            0 => array:3 [
              "identificador" => "bb0005"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of inflammatory bowel disease in Spain&#46; A systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Pajares"
                            1 => "J&#46;P&#46; Gisbert"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Enferm Dig"
                        "fecha" => "2001"
                        "volumen" => "93"
                        "paginaInicial" => "9"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11488104"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tratamiento de la EICI en la infancia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;J&#46; Vilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "Conductas de actuaci&#243;n en la enfermedad inflamatoria cr&#243;nica intestinal"
                        "edicion" => "4&#46;&#170; ed&#46;"
                        "serieFecha" => "2007"
                      ]
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                ]
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              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous elemental enteral alimentation in the treatment of children and adolescents with Crohn&#39;s disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;L&#46; Morin"
                            1 => "M&#46; Roulet"
                            2 => "C&#46;C&#46; Roy"
                            3 => "A&#46; Weber"
                            4 => "N&#46; Lapointe"
                          ]
                        ]
                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JPEN J Parenter Enteral Nutr"
                        "fecha" => "1982"
                        "volumen" => "6"
                        "paginaInicial" => "194"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6809974"
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ORIGINALES
Eficacia del tratamiento nutricional primario en la enfermedad de Crohn pediátrica
Efficacy of Exclusive Enteral Feeding as Primary Therapy for Paediatric Crohn's Disease
V.M. Navas Lópeza,
Autor para correspondencia
victor.navas@gmail.com

Dr. V.M. Navas López. Sección de Gastroenterología y Nutrición Infantil. Servicio de Pediatría. Hospital Materno-Infantil. Hospital Carlos Haya. Avda. rroyo de los Ángeles, s/n. 29011 Málaga. España.
, J. Blasco Alonsoa, C. Sierra Salinasa, A. Barco Gálveza, M.I. Vicioso Reciob
a Sección de Gastroenterología y Nutrición Infantil. Servicio de Pediatría. España
b Servicio de Laboratorio. Hospital Materno-Infantil. Hospital Regional Universitario Carlos Haya. Málaga. España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0005">INTRODUCCI&#211;N</span><p id="p0005" class="elsevierStylePara elsevierViewall">La enfermedad de Crohn es un trastorno inflamatorio cr&#243;nico que afecta a uno o a varios segmentos del tracto digestivo &#40;desde la boca hasta el ano&#41; de forma discontinua&#44; que cursa en forma de brotes y que&#44; en ocasiones&#44; se acompa&#241;a de manifestaciones extradigestivas&#46; La inflamaci&#243;n se extiende a menudo hasta la serosa&#44; las zonas inflamadas se alternan con &#225;reas sanas y es frecuente que se formen f&#237;stulas&#46; El intestino delgado est&#225; afectado en el 90 &#37; de los casos&#44; sobre todo el &#237;leon terminal &#40;en el 70&#37; de los casos&#41;&#46; En m&#225;s del 50 &#37; de las ocasiones la localizaci&#243;n es ileoc&#243;lica y en el 10 &#37;&#44; s&#243;lo col&#243;nica&#46; La incidencia de la enfermedad de Crohn en Espa&#241;a oscila entre 0&#44;4 y 5&#44;5 casos &#215; 10<span class="elsevierStyleSup">5</span> habitantes&#47;a&#241;o&#44; con un valor medio de 1&#44;9 casos &#215; 10<span class="elsevierStyleSup">5</span> habitantes&#47;a&#241;o y con una importante variabilidad geogr&#225;fica<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a>&#46; El 20-30 &#37; de los nuevos casos de enfermedad de Crohn se diagnostican en menores de 18 a&#241;os&#46; Una peculiaridad de la enfermedad de Crohn pedi&#225;trica es su repercusi&#243;n sobre el crecimiento y el desarrollo puberal&#46; En el 5 &#37; de los pacientes el fallo del crecimiento puede ser la &#250;nica manifestaci&#243;n de la enfermedad&#46; El objetivo fundamental del tratamiento de la enfermedad de Crohn es la curaci&#243;n de la mucosa y a &#233;ste se a&#241;aden&#58; mejorar la calidad de vida&#44; recuperar y mantener un crecimiento adecuado&#44; asegurar un desarrollo puberal correcto y prevenir complicaciones a largo plazo derivadas de la enfermedad y del tratamiento empleado<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">El tratamiento nutricional primario &#40;TNP&#41; consiste en la administraci&#243;n de dieta exclusiva con f&#243;rmula enteral durante un per&#237;odo no inferior a 6&#8211;8 semanas&#46; Esta pauta ha demostrado ser efectiva para inducir la remisi&#243;n cl&#237;nica en ni&#241;os afectados de enfermedad de Crohn con tasas de respuesta cercanas al 80&#37;<a class="elsevierStyleCrossRefs" href="#bb0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; La remisi&#243;n cl&#237;nica no siempre se asocia con la remisi&#243;n histol&#243;gica o con la curaci&#243;n de la mucosa&#46; La endoscopia digestiva con toma de biopsias y su posterior an&#225;lisis histol&#243;gico es la herramienta utilizada con patr&#243;n de referencia para conocer el grado de inflamaci&#243;n intestinal&#46; Es una t&#233;cnica invasiva y cara&#44; que precisa una preparaci&#243;n cuidadosa del colon y anestesia general para su realizaci&#243;n&#46; Las colonoscopias seriadas para comprobar la remisi&#243;n histol&#243;gica no est&#225;n al alcance de todos los centros sanitarios y suelen ser mal aceptadas por parte de los pacientes y de sus familiares&#46; En la actualidad se dispone de m&#233;todos de laboratorio que informan acerca del estado inflamatorio intestinal&#46; Entre ellos destacan la cuantificaci&#243;n en sangre&#47;heces de prote&#237;nas derivadas de los leucocitos &#40;prote&#237;na cati&#243;nica eosinof&#237;lica&#44; esterasa&#44; mieloperoxidasa&#44; lisozima&#44; lactoferrina o calprotectina&#41;&#46; Esta &#250;ltima es la prote&#237;na que m&#225;s abunda en el citoplasma del neutr&#243;filo y del macr&#243;fago&#44; es muy estable en las heces&#44; permanece inalterada durante m&#225;s de 7 d&#237;as&#44; permitiendo la conservaci&#243;n de las muestras hasta su env&#237;o y an&#225;lisis&#46; Es un marcador no invasivo&#44; con alta sensibilidad y especificidad&#44; que permite monitorizar la actividad inflamatoria en ni&#241;os y adultos&#44; y predecir la reca&#237;da cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bb0030"><span class="elsevierStyleSup">6&#44;7</span></a>&#46; Las concentraciones de calprotectina fecal est&#225;n estrechamente relacionadas con los hallazgos endosc&#243;picos e histol&#243;gicos&#46; Es un test de ELISA simple y econ&#243;mico&#44; que requiere una cantidad m&#237;nima de heces &#40;50&#8211;100 mg&#41; para su realizaci&#243;n&#46; Los valores aceptados como normales de calprotectina fecal en ni&#241;os mayores de 1 a&#241;o son de 50 &#956;g&#47;g de heces&#44; con una sensibilidad del 90 &#37; y una especificidad del 83 &#37; para correlacionarlos con procesos inflamatorios intestinales<a class="elsevierStyleCrossRefs" href="#bb0040"><span class="elsevierStyleSup">8&#8211;13</span></a>&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Los objetivos de nuestro estudio son los siguientes&#58;<ul class="elsevierStyleList" id="l0005"><li class="elsevierStyleListItem" id="o0005"><span class="elsevierStyleLabel">1&#46;</span><p id="p0020" class="elsevierStylePara elsevierViewall">Determinar la eficacia del TNP para inducir la remisi&#243;n cl&#237;nica en el primer brote de enfermedad de Crohn en ni&#241;os&#46;</p></li><li class="elsevierStyleListItem" id="o0010"><span class="elsevierStyleLabel">2&#46;</span><p id="p0025" class="elsevierStylePara elsevierViewall">Determinar la eficacia del TNP para mejorar el grado de inflamaci&#243;n de la mucosa intestinal utilizando como marcador la calprotectina fecal&#46;</p></li><li class="elsevierStyleListItem" id="o0015"><span class="elsevierStyleLabel">3&#46;</span><p id="p0030" class="elsevierStylePara elsevierViewall">Estimar la tasa de cumplimiento del TNP&#46;</p></li></ul></p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">PACIENTES Y M&#201;TODOS</span><p id="p0035" class="elsevierStylePara elsevierViewall">En este estudio prospectivo observacional se incluyeron todos los pacientes menores de 14 a&#241;os diagnosticados de enfermedad de Crohn atendiendo a criterios cl&#237;nicos&#44; radiol&#243;gicos&#44; endosc&#243;picos y anatomopatol&#243;gicos entre enero de 2002 y octubre de 2007&#44; y que recibieron alimentaci&#243;n exclusiva con f&#243;rmula polim&#233;rica &#40;Modulen IBD&#44; Nestl&#233;&#44; Vevey&#44; Suiza&#41; durante el primer brote de su enfermedad&#46; Quedaron excluidos los pacientes diagnosticados de colitis ulcerosa&#44; colitis indeterminada&#44; colitis eosinof&#237;lica o colitis infecciosa&#44; as&#237; como los diagnosticados de enfermedad de Crohn que recibieron tratamiento concomitante o previo con corticoides y&#47;o f&#225;rmacos inmunosupresores &#40;azatioprina&#44; 6-mercaptopurina&#44; entre otros&#41;&#46;</p><p id="p0040" class="elsevierStylePara elsevierViewall">Modulen IBD se prepar&#243; mezclando 1&#46;700 ml de agua con 400 g de producto&#44; lo que daba lugar a 2&#46;000 ml de una f&#243;rmula normocal&#243;rica &#40;1 kcal&#47;ml&#41;&#46; El c&#225;lculo de las necesidades energ&#233;ticas se estim&#243; mediante la f&#243;rmula de Schofield&#46; La pauta de administraci&#243;n fue de 4&#8211;5 tomas al d&#237;a&#44; y s&#243;lo se permit&#237;a la ingesti&#243;n de agua durante el tratamiento&#46;</p><p id="p0045" class="elsevierStylePara elsevierViewall">Los datos recogidos fueron edad&#44; sexo&#44; antecedentes familiares de enfermedad inflamatoria intestinal cr&#243;nica &#40;EIIC&#41;&#44; tiempo transcurrido hasta el diagn&#243;stico y tratamiento farmacol&#243;gico asociado &#40;5-aminosalicilatos &#91;5-ASA&#93; y&#47;o metronidazol&#41;&#46; El fenotipo de la enfermedad de Crohn se estableci&#243; atendiendo a la clasificaci&#243;n de Montreal &#40;<a class="elsevierStyleCrossRef" href="#t0005">tabla 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a>&#46;</p><elsevierMultimedia ident="t0005"></elsevierMultimedia><p id="p0050" class="elsevierStylePara elsevierViewall">Todos los pacientes fueron valorados al inicio del tratamiento&#44; a las 4 semanas y al final de la octava semana de tratamiento&#46; En estos tres controles se recogieron los siguientes datos&#58; peso&#44; talla&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; calprotectina fecal &#40;Calprest&#44; Eurospital&#44; Italia&#41; y se determin&#243; el &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica &#40;PCDAI&#41;<a class="elsevierStyleCrossRef" href="#bb0075"><span class="elsevierStyleSup">15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#t0010">tabla 2</a>&#41;&#46; La remisi&#243;n cl&#237;nica se defini&#243; cuando el PCDAI era igual o inferior a 10&#46; Se consideraron como normales valores de calprotectina fecal inferiores a 50 &#956;g&#47;g de heces&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">An&#225;lisis estad&#237;stico</span><p id="p0055" class="elsevierStylePara elsevierViewall">Utilizamos el programa estad&#237;stico SPSS versi&#243;n 13&#46;0&#46; El contraste de muestras apareadas se realiz&#243; con el contraste de Wilcoxon&#46; El coeficiente de correlaci&#243;n entre las variables se estableci&#243; con el coeficiente de Spearman&#46; Se consider&#243; un valor de p &#60; 0&#44;05 como estad&#237;sticamente significativo&#46;</p></span></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">RESULTADOS</span><p id="p0060" class="elsevierStylePara elsevierViewall">Se incluy&#243; un total de 14 pacientes &#40;9 varones&#41;&#44; con una edad media en el momento del diagn&#243;stico de 10&#44;74 &#177; 2&#44;56 a&#241;os&#46; S&#243;lo 2 pacientes ten&#237;an antecedentes familiares de EIIC &#40;uno de colitis ulcerosa y otro de enfermedad de Crohn&#41;&#46; El tiempo medio transcurrido desde el inicio de los s&#237;ntomas hasta la confirmaci&#243;n diagn&#243;stica fue de 104&#44;72 &#177; 52&#44;7 d&#237;as&#46; El fenotipo m&#225;s frecuente fue L3B1A1 &#40;50 &#37;&#41;&#44; seguido de L3-L4B1A1 &#40;21&#44;4 &#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#41;&#46; La afectaci&#243;n perianal se observ&#243; en 3 pacientes &#40;21&#44;4 &#37;&#41;&#46; En todos los casos el patr&#243;n cl&#237;nico fue inflamatorio&#46; Modulen IBD fue bien tolerado&#44; ning&#250;n paciente requiri&#243; sonda nasog&#225;strica para su administraci&#243;n y ninguno abandon&#243; la dieta antes de las 8 semanas&#46; Todos recibieron aminosalicilatos &#40;50&#8211;100 mg&#47;kg&#47;d&#237;a&#41; y cuatro de ellos&#44; adem&#225;s&#44; metronidazol &#40;20&#8211;30 mg&#47;kg&#47;d&#237;a&#41; &#40;<a class="elsevierStyleCrossRef" href="#t0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia><p id="p0065" class="elsevierStylePara elsevierViewall">Al inicio del TNP&#44; el peso fue de 37&#44;03 &#177; 11&#44;29 kg&#44; el PCDAI de 30&#44;17 &#177; 11&#44;15 y los valores de calprotectina fecal de 512 &#177; 235 &#956;g&#47;g heces&#46; A las 4 semanas&#44; el 71&#37; de los pacientes &#40;10 de 14 casos&#41; hab&#237;a alcanzado la remisi&#243;n cl&#237;nica &#40;<a class="elsevierStyleCrossRef" href="#f0005">fig&#46; 1</a>&#41;&#44; que se acompa&#241;&#243; de un descenso no significativo de las cifras de calprotectina fecal &#40;p &#61; 0&#44;221&#41;&#46; A las 8 semanas&#44; el 85 &#37; de los pacientes estaba en remisi&#243;n cl&#237;nica &#40;p &#61; 0&#44;001&#41; y la excreci&#243;n fecal de calprotectina hab&#237;a experimentado un descenso significativo &#40;p &#61; 0&#44;03&#41;&#44; sin alcanzar en ning&#250;n momento valores normales &#40;<a class="elsevierStyleCrossRef" href="#f0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="f0010"></elsevierMultimedia><p id="p0070" class="elsevierStylePara elsevierViewall">Se observ&#243; un incremento de peso y talla al final del TNP &#40;<a class="elsevierStyleCrossRef" href="#t0020">tabla 4</a>&#41;&#46; El coeficiente de Spearman entre el PCDAI y la calprotectina fecal de nuestra muestra fue de 0&#44;449 &#40;p &#61; 0&#44;003&#41;&#46;</p><elsevierMultimedia ident="t0020"></elsevierMultimedia></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">DISCUSI&#211;N</span><p id="p0075" class="elsevierStylePara elsevierViewall">Los mecanismos de acci&#243;n de la nutrici&#243;n enteral sobre la inflamaci&#243;n intestinal en la enfermedad de Crohn se desconocen&#59; entre las hip&#243;tesis se incluyen la modificaci&#243;n en la flora intestinal&#44; la eliminaci&#243;n de la captaci&#243;n de ant&#237;genos alimentarios&#44; la disminuci&#243;n de la s&#237;ntesis intestinal de mediadores inflamatorios a causa de una reducci&#243;n de la grasa en la dieta o el aporte de micronutrientes al intestino enfermo<a class="elsevierStyleCrossRef" href="#bb0080"><span class="elsevierStyleSup">16</span></a>&#46; Numerosos ensayos realizados en adultos y en ni&#241;os ponen de manifiesto que no existen diferencias en la tasa de remisi&#243;n ni en el cumplimiento del tratamiento nutricional en relaci&#243;n con la f&#243;rmula enteral empleada &#40;polim&#233;rica&#44; semielemental o elemental&#41;<a class="elsevierStyleCrossRefs" href="#bb0085"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46; Tampoco se han demostrado ventajas con suplementos en glutamina ni con triglic&#233;ridos de cadena media<a class="elsevierStyleCrossRefs" href="#bb0100"><span class="elsevierStyleSup">20&#44;21</span></a>&#46;</p><p id="p0080" class="elsevierStylePara elsevierViewall">Actualmente no existen datos que demuestren la eficacia de los aminosalicilatos &#40;5-ASA&#41; en la inducci&#243;n a la remisi&#243;n en ni&#241;os con enfermedad de Crohn&#46; S&#237; se han referido datos en adultos&#59; en un metaan&#225;lisis llevado a cabo en 600 pacientes adultos con enfermedad de Crohn<a class="elsevierStyleCrossRef" href="#bb0110"><span class="elsevierStyleSup">22</span></a> se ha puesto de manifiesto un descenso significativo del CDAI de 63 puntos en los pacientes tratados con 5-ASA frente a 45 puntos en los que recibieron placebo&#46; Esta diferencia de 18 puntos&#44; pese a ser significativa&#44; carece de relevancia cl&#237;nica&#46; En cuanto al empleo de metronidazol&#44; un estudio controlado con placebo en la enfermedad de Crohn activa no demostr&#243; la existencia de diferencias significativas con respecto al placebo&#44; tras 16 semanas de tratamiento<a class="elsevierStyleCrossRef" href="#bb0115"><span class="elsevierStyleSup">23</span></a>&#46; Estos argumentos apoyan que el tratamiento coadyuvante con 5-ASA y&#47;o metronidazol en nuestra muestra no haya influido en la tasa final de remisi&#243;n&#46;</p><p id="p0085" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#t0025">tabla 5</a> se exponen los datos de los estudios realizados en ni&#241;os &#40;duraci&#243;n&#44; tipo de f&#243;rmula&#44; criterios para definir la remisi&#243;n cl&#237;nica y tasa de remisi&#243;n&#41;&#46;</p><elsevierMultimedia ident="t0025"></elsevierMultimedia><p id="p0090" class="elsevierStylePara elsevierViewall">Ludvigsson et al<a class="elsevierStyleCrossRef" href="#bb0090"><span class="elsevierStyleSup">18</span></a> incluyeron a 31 pacientes menores de 17 a&#241;os diagnosticados de enfermedad de Crohn&#59; 16 recibieron f&#243;rmula elemental &#40;Elemental 028&#44; SHS&#44; Reino Unido&#41; y 17&#44; f&#243;rmula polim&#233;rica &#40;Nutrison Standard&#44; Nutricia&#44; Pa&#237;ses Bajos&#41;&#44; durante 6 semanas&#46; Se encontr&#243; una tasa de remisi&#243;n del 69 &#37; para los pacientes que tomaban f&#243;rmula elemental frente al 82 &#37; de los que tomaron f&#243;rmula polim&#233;rica &#40;p &#61; NS&#41;&#46; Fell et al<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> administraron Modulen IBD a 29 pacientes &#40;17 en primer brote y 12 en reca&#237;da&#41; durante 8 semanas&#59; el 79 &#37; se encontraba en remisi&#243;n cl&#237;nica al final de este per&#237;odo&#46; Day et al<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a> seleccionaron a 27 pacientes &#40;15 en primer brote y 12 en reca&#237;da&#41;&#59; todos recibieron f&#243;rmula polim&#233;rica durante 6&#8211;8 semanas&#44; bien Modulen IBD &#40;Nestl&#233;&#44; Sidney&#44; NSW&#44; Australia&#41; u Osmolite &#40;Abbott Nutrition Internacional&#44; Botany&#44; NSW&#44; Australia&#41;&#46; La tasa global de remisi&#243;n&#44; por protocolo&#44; fue del 79&#37; &#40;del 80 &#37; en los nuevos pacientes y del 58 &#37; en los pacientes en reca&#237;da&#41;&#46; Borrelli et al<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&#44; en un estudio prospectivo y aleatorizado que comparaba la eficacia de la f&#243;rmula polim&#233;rica &#40;Modulen IBD&#41; frente a los corticoides para inducir la remisi&#243;n cl&#237;nica&#44; endosc&#243;pica e histol&#243;gica en una muestra de 19 pacientes con nuevo diagn&#243;stico de enfermedad de Crohn&#44; encontraron que al final de las 10 semanas de tratamiento nutricional el 79 &#37; de los pacientes se encontraban en remisi&#243;n cl&#237;nica&#46;</p><p id="p0100" class="elsevierStylePara elsevierViewall">Sanderson et al<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> administraron por sonda nasog&#225;strica a 9 pacientes una dieta elemental &#40;Flexical&#41; durante 6 semanas&#44; al final de las cuales se encontraba en remisi&#243;n el 89 &#37; de los pacientes&#46; Ruuska et al<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a> obtuvieron tambi&#233;n esta tasa de remisiones tras administrar a 10 ni&#241;os Nutrison Standard &#40;Nutricia&#41; durante 8 semanas&#46; Thomas et al<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> utilizaron Elemental 028 en 12 ni&#241;os durante 4 semanas&#44; con una respuesta cl&#237;nica excelente&#46;</p><p id="p0105" class="elsevierStylePara elsevierViewall">Johnson et al<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a> compararon dos modalidades distintas de tratamiento nutricional en un grupo de 50 pacientes diagnosticados de enfermedad de Crohn&#46; Emplearon la f&#243;rmula Elemental 028 Extra &#40;SHS&#44; International&#41; en todos los pacientes durante 6 semanas&#59; 26 de ellos recibieron la mitad de sus necesidades cal&#243;ricas diarias en forma de f&#243;rmula elemental y el resto mediante dieta normal &#40;modalidad nutrici&#243;n enteral parcial&#44; NEP&#41;&#46; Por otro lado&#44; 24 pacientes recibieron todas sus necesidades cal&#243;ricas en forma de f&#243;rmula elemental &#40;modalidad nutrici&#243;n enteral total&#44; NET&#41;&#46; Al final de las 6 semanas&#44; el 62 &#37; de los pacientes con NET frente al 25 &#37; de los que recib&#237;an NEP se encontraban en remisi&#243;n cl&#237;nica&#46; Afzal et al<a class="elsevierStyleCrossRef" href="#bb0150"><span class="elsevierStyleSup">30</span></a> administraron una f&#243;rmula polim&#233;rica &#40;ACD004&#44; Nestl&#233;&#41; similar a Modulen IBD pero con diferente composici&#243;n grasa durante 8 semanas&#44; sin permitir otros alimentos a 26 pacientes&#44; alcanzando el 85 &#37; de ellos la remisi&#243;n cl&#237;nica al final del tratamiento&#46; Akobeng et al<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a> dividieron en dos grupos a 18 pacientes con enfermedad de Crohn&#59; a nueve de ellos les administraron una f&#243;rmula polim&#233;rica con bajo contenido en glutamina y al resto una f&#243;rmula polim&#233;rica enriquecida en glutamina&#46; No se encontraron diferencias significativas en la tasa de remisi&#243;n entre ambos grupos y al final de las 4 semanas de tratamiento el 56&#37; hab&#237;a alcanzado la remisi&#243;n cl&#237;nica&#46;</p><p id="p0110" class="elsevierStylePara elsevierViewall">Terrin et al<a class="elsevierStyleCrossRef" href="#bb0145"><span class="elsevierStyleSup">29</span></a> administraron alimentaci&#243;n exclusiva con f&#243;rmula semielemental &#40;Pregomin&#44; Milupa&#41; durante 8 semanas a un grupo de 10 pacientes&#59; el 90 &#37; alcanz&#243; la remisi&#243;n cl&#237;nica&#46; Papadopoulou et al<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a> encontraron una tasa de remisi&#243;n del 83 &#37; en un grupo de 19 pacientes tratados con dieta elemental &#40;E028&#44; SHS&#44; Liverpool&#44; Reino Unido&#41; durante 6 semanas&#46;</p><p id="p0115" class="elsevierStylePara elsevierViewall">Beattie et al<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a> utilizaron una dieta polim&#233;rica enriquecida con TGF-&#946; en 7 pacientes menores de 18 a&#241;os durante 8 semanas&#44; al final de las cuales observaron una mejor&#237;a cl&#237;nica muy significativa en todos los pacientes&#44; junto con una aceptable ganancia ponderal y una normalizaci&#243;n de los valores de prote&#237;na C reactiva &#40;PCR&#41; y de alb&#250;mina plasm&#225;ticas&#46; Rodrigues et al<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a> dividieron a 98 ni&#241;os con enfermedad de Crohn en su primer brote de enfermedad en dos grupos para recibir una f&#243;rmula polim&#233;rica &#40;Clinutren&#44; Nestl&#233; Clinical Nutrition&#44; Deerfield&#44; IL&#44; EE&#46;UU&#46;&#41;&#44; Fortisip &#40;Nutricia&#44; Trowbridge&#44; Reino Unido&#41; o Ensure plus &#40;Abbott Laboratories&#44; Chicago&#44; IL&#44; EE&#46;UU&#46;&#41; o una elemental &#40;Elemental 028 o Elemental 028 Extra &#91;SHS International&#44; Liverpool&#44; Reino Unido&#93;&#41; durante 6 semanas&#46; Las tasas de remisi&#243;n fueron del 51 y del 64 &#37; &#40;p &#61; 0&#44;19&#41;&#44; respectivamente&#46; Knight et al<a class="elsevierStyleCrossRef" href="#bb0155"><span class="elsevierStyleSup">31</span></a> publicaron los datos de 44 ni&#241;os que hab&#237;an recibido durante 6 semanas bien Elemental 028 &#40;SHS International Limited&#44; Liverpool&#44; Reino Unido&#41; o bien Ensure Plus &#40;Abbott Laboratories Limited&#44; Maidenhead&#44; Reino Unido&#41;&#46; La tasa de remisi&#243;n global fue del 90 &#37;&#46; Berni Canani et al<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> emplearon Modulen IBD en 12 pacientes&#44; Pregomin en 13 casos y f&#243;rmula elemental &#40;Neocate&#44; Nutricia&#44; Italia&#41; en 12 pacientes&#46; El 86&#44;5 &#37; alcanz&#243; la remisi&#243;n al final de las 8 semanas&#46;</p><p id="p0120" class="elsevierStylePara elsevierViewall">Analizando los datos expuestos en la <a class="elsevierStyleCrossRef" href="#t0025">tabla 5</a>&#44; la tasa global de remisi&#243;n&#44; por intenci&#243;n de tratar&#44; fue del 76&#44;5 &#37;&#44; y por protocolo&#44; del 84&#44;4 &#37;&#44; con una tasa de cumplimiento del 90 &#37;&#46; Si agrupamos los estudios de 8 semanas de duraci&#243;n y con el criterio de remisi&#243;n cl&#237;nica de PCDAI inferior a 10 y los comparamos con nuestra serie&#44; los resultados son similares &#40;tasa de remisi&#243;n por protocolo del 90&#44;3&#37; frente al 85 &#37; y por intenci&#243;n de tratar del 86&#44;5 &#37; frente al 85 &#37;&#59; cumplimiento del 98&#44;25&#37; frente al 100 &#37;&#41;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0140"><span class="elsevierStyleSup">28&#44;29</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&#46; Para asegurar el cumplimiento terap&#233;utico es importante explicarles a los pacientes y a sus familiares el objetivo y la duraci&#243;n del tratamiento&#44; as&#237; como las alternativas de las que se dispone para su administraci&#243;n en caso de falta de tolerancia oral&#46; La diferencia apreciada entre los distintos estudios puede deberse al tama&#241;o de la muestra&#44; a los distintos criterios de remisi&#243;n empleados y a la f&#243;rmula administrada&#46;</p><p id="p0125" class="elsevierStylePara elsevierViewall">El objetivo principal en el tratamiento de la enfermedad de Crohn es la remisi&#243;n histol&#243;gica o la curaci&#243;n de la mucosa&#46; En relaci&#243;n con este aspecto&#44; existen varios trabajos que eval&#250;an de una u otra forma la mejor&#237;acuraci&#243;n de la mucosa intestinal&#46; En este sentido&#44; Fell et al<a class="elsevierStyleCrossRef" href="#bb0140"><span class="elsevierStyleSup">28</span></a> repitieron la colonoscopia a 26 pacientes al finalizar las 8 semanas de TNP y encontraron una mejor&#237;a en el 50 &#37; de los casos y curaci&#243;n en el 30 &#37;&#46; Cuando analizaron los hallazgos del &#237;leon terminal&#44; el 68 &#37; hab&#237;a mejorado y se hab&#237;a curado el 53 &#37;&#46; El an&#225;lisis histol&#243;gico puso de manifiesto una mejor&#237;a en el 48 &#37; de las biopsias col&#243;nicas &#40;curaci&#243;n histol&#243;gica en el 8 &#37;&#41; y en el 65 &#37; de las de &#237;leon terminal &#40;curaci&#243;n histol&#243;gica en el 40 &#37;&#41;&#46;</p><p id="p0130" class="elsevierStylePara elsevierViewall">Borrelli et al<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&#44; tras las 10 semanas de nutrici&#243;n enteral con f&#243;rmula polim&#233;rica&#44; observaron una mejor&#237;a significativa en los &#237;ndices endosc&#243;picos e histol&#243;gicos&#44; tanto en el &#237;leon terminal como en el colon&#46; Tambi&#233;n Berni Canani et al<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a> constataron una mejor&#237;a significativa en los &#237;ndices histol&#243;gicos y endosc&#243;picos de los pacientes sometidos a TNP&#44; independientemente de la f&#243;rmula utilizada&#46; Beattie et al<a class="elsevierStyleCrossRef" href="#bb0185"><span class="elsevierStyleSup">37</span></a>&#44; tras el an&#225;lisis de las muestras obtenidas despu&#233;s de 8 semanas de tratamiento&#44; demostraron una mejor&#237;a histol&#243;gica en el 85 &#37; de los casos &#40;6 de 7 casos&#41;&#44; y dos de ellos alcanzaron la remisi&#243;n histol&#243;gica&#46;</p><p id="p0135" class="elsevierStylePara elsevierViewall">En nuestra serie encontramos una disminuci&#243;n de los valores de calprotectina fecal al final de las 8 semanas en el 71 &#37; de los pacientes&#44; lo que puede interpretarse como una mejor&#237;a del grado de inflamaci&#243;n intestinal&#44; y en ning&#250;n caso se alcanzaron valores inferiores a 50 &#956;g&#47;g de heces&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">Exist&#237;a una idea inicial de que el tratamiento nutricional era m&#225;s efectivo en pacientes con afectaci&#243;n ileal que en los que presentaban una enfermedad de localizaci&#243;n exclusivamente col&#243;nica&#46; En la actualidad no existen datos que permitan establecer una correlaci&#243;n entre la respuesta al TNP y el fenotipo de la enfermedad&#46;</p><p id="p0145" class="elsevierStylePara elsevierViewall">Uno de los aspectos m&#225;s debatidos en las &#250;ltimas dos d&#233;cadas es la eficacia del tratamiento nutricional frente a los esteroideos para inducir la remisi&#243;n en pacientes afectados de enfermedad de Crohn&#46; Trabajos realizados en ni&#241;os como los de Sanderson et al<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a> o de Thomas et al<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a> ya pon&#237;an de manifiesto hace 15&#8211;20 a&#241;os que la efectividad de los corticoides para inducir la remisi&#243;n era similar a la de la nutrici&#243;n enteral&#46; Esos datos no se reflejaban en los estudios llevados a cabo en adultos ni en los tres metaan&#225;lisis<a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRefs" href="#bb0190"><span class="elsevierStyleSup">38&#44;39</span></a> que analizaban conjuntamente resultados de series pedi&#225;tricas y de adultos&#44; en los que se observaba mayor eficacia con el tratamiento esteroideo&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">Dos metaan&#225;lisis de ensayos pedi&#225;tricos llegan a la conclusi&#243;n de que el tratamiento nutricional en la enfermedad de Crohn pedi&#225;trica es tan eficaz como los corticoides en la inducci&#243;n de la remisi&#243;n de la enfermedad&#44; pero sin sus efectos delet&#233;reos<a class="elsevierStyleCrossRefs" href="#bb0200"><span class="elsevierStyleSup">40&#44;41</span></a>&#46; Tambi&#233;n dos estudios recientes han comprobado que el tratamiento nutricional es m&#225;s eficaz que los esteroides para mejorar la inflamaci&#243;n intestinal&#44; recuperar el crecimiento y mantener la remisi&#243;n cl&#237;nica<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el TNP ha demostrado ser efectivo en la inducci&#243;n a la remisi&#243;n cl&#237;nica e histol&#243;gica en ni&#241;os con enfermedad de Crohn&#44; independientemente del fenotipo&#46; En general es bien tolerado y su eficacia para inducir la remisi&#243;n cl&#237;nica es similar a la de los esteroides&#44; pero sin sus efectos secundarios&#46;</p><p id="p0160" class="elsevierStylePara elsevierViewall">La correlaci&#243;n entre PCDAI y calprotectina fecal es baja&#44; y se necesitan las dos herramientas para el seguimiento de los pacientes&#46; Una explicaci&#243;n detallada del plan de tratamiento al paciente y a sus familiares puede desembocar en el &#233;xito del cumplimiento del TNP&#46; Debemos informar a nuestros pacientes de la posibilidad del uso de sonda nasog&#225;strica y dejar a su elecci&#243;n la v&#237;a de administraci&#243;n de la f&#243;rmula polim&#233;rica&#46; Debido al corto per&#237;odo de tiempo en el que se ha de administrar el TNP no creemos indicada la realizaci&#243;n de una gastrostom&#237;a&#46;</p><p id="p0165" class="elsevierStylePara elsevierViewall">El TNP administrado durante un per&#237;odo de 8 semanas puede inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n de la mucosa intestinal&#44; lo que se refleja en la disminuci&#243;n de las cifras de calprotectina fecal&#46;</p></span></span>"
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    "fechaRecibido" => "2008-06-30"
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            0 => "Crohn&#39;s disease"
            1 => "Inflammatory bowel disease"
            2 => "Nutritional therapy"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="sp0075" class="elsevierStyleSimplePara elsevierViewall">El tratamiento nutricional primario &#40;TNP&#41;&#44; que consiste en la administraci&#243;n de dieta exclusiva con f&#243;rmula enteral &#40;polim&#233;rica&#44; semielemental o elemental&#41; durante un per&#237;odo no inferior a 6-8 semanas&#44; ha demostrado ser efectivo para inducir la remisi&#243;n cl&#237;nica en ni&#241;os afectados de enfermedad de Crohn&#46; La remisi&#243;n cl&#237;nica no siempre conlleva la remisi&#243;n histol&#243;gica o la curaci&#243;n de la mucosa&#46; La calprotectina fecal es un excelente marcador de la actividad inflamatoria intestinal y sus concentraciones se correlacionan estrechamente con el grado de inflamaci&#243;n de la mucosa intestinal&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="sp0080" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio prospectivo observacional en el que se incluyeron todos los pacientes menores de 14 a&#241;os diagnosticados de enfermedad de Crohn entre enero de 2002 y octubre de 2007 que recibieron alimentaci&#243;n exclusiva con f&#243;rmula polim&#233;rica &#40;Modulen IBD&#44; Nestl&#233;&#44; Vevey&#44; Suiza&#41; durante su primer brote de enfermedad&#46; Se establecieron controles cl&#237;nicos &#40;peso&#44; talla&#44; &#237;ndice de masa corporal&#44; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica &#91;PCDAI&#93;&#41; y determinaciones de calprotectina fecal al inicio&#44; y a las 4 y 8 semanas de tratamiento&#46; La remisi&#243;n cl&#237;nica se defini&#243; cuando el PCDAI era igual o inferior a 10&#46; Se consideraron normales valores de calprotectina fecal inferiores a 50 &#956;g&#47;g de heces&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="sp0085" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 14 pacientes &#40;9 varones&#41;&#44; con una edad media en el momento del diagn&#243;stico de 10&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;56 a&#241;os&#46; A las 4 semanas&#44; el 71 &#37; de los pacientes alcanzaron la remission cl&#237;nica&#44; que se acompa&#241;&#243; de un descenso no significativo de las cifras de calprotectina fecal&#46; A las 8 semanas&#44; el 85 &#37; de los pacientes logr&#243; la remisi&#243;n cl&#237;nica y los valores de calprotectina fecal hab&#237;an descendido de forma significativa&#44; aunque sin alcanzar concentraciones normales&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="sp0090" class="elsevierStyleSimplePara elsevierViewall">El TNP administrado durante un per&#237;odo de 8 semanas puede inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n de la mucosa intestinal&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="sp0095" class="elsevierStyleSimplePara elsevierViewall">The primary nutritional therapy &#40;PNT&#41;&#44; which consists in the administration of exclusive enteral formula feeds &#40;polymeric&#44; semi-elemental or elemental formula&#41; for a period of no less than 6-8 weeks&#44; has proven to be effective in inducing clinical remission in children with Crohn&#39;s disease&#46; The clinical remission does not always include histological remission or cure of the mucosa&#46; Faecal calprotectin is closely correlated with endoscopic and histological findings but is slightly associated with clinical activity scores&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="sp0100" class="elsevierStyleSimplePara elsevierViewall">An observational prospective study including all patients under 14 years of age diagnosed with Crohn&#39;s disease between January 2002 and October 2007&#44; and who were fed exclusively with polymeric formula &#40;Modulen IBD&#44; Nestle&#44; Vevey&#44; Switzerland&#41; during the onset of the disease&#46; Clinical controls were carried out &#40;weight&#44; height&#44; body mass index &#91;BMI&#41; and the Paediatric Crohn&#39;s Disease Activity Index &#91;PCDAI&#41;&#41; and faecal calprotectin was measured at the beginning and at weeks 4 and 8 of treatment&#46; The clinical remission was defined as having a PCDAI less than or equal to 10&#46; Faecal calprotectin values below 50 &#956;g&#47;g faeces were considered as normal&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="sp0105" class="elsevierStyleSimplePara elsevierViewall">There were 14 patients &#40;9 males&#41;&#44; mean age at diagnosis of 10&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;56 years&#46; At week 4&#44; 71 &#37; of patients &#40;10&#47;14&#41; had achieved clinical remission and a decrease in faecal calprotectin levels that was not significant&#46; After 8 weeks&#44; 85 &#37; of our patients were in clinical remission and faecal calprotectin values had declined significantly without reaching normal levels&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="sp0110" class="elsevierStyleSimplePara elsevierViewall">Primary nutritional therapy administered over a period of 8 weeks is capable of inducing clinical remission and improving the degree of inflammation of the intestinal mucosa&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60; 16 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>17-40 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#205;leon terminal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">L1 &#43; L4 &#40;&#237;leon &#43; tracto digestivo alto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Colon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L2 &#43; L4 &#40;colon &#43; tracto digestivo alto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ileoc&#243;lica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3 &#43; L4 &#40;ileoc&#243;lica &#43; tracto digestivo alto&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tracto digestivo alto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Patr&#243;n cl&#237;nico</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#40;B&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflamatorio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B1p &#40;inflamatorio con afecci&#243;n perianal asociada&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estenosante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B2p &#40;estenosante con afecci&#243;n perianal asociada&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fistulizante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">B3p &#40;fistulizante con afecci&#243;n perianal asociada&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Puntuaci&#243;n total &#40;0 a 100&#41;&#58; PCDAI &#8805; 30&#58; enfermedad moderada o grave&#59; PCDAI &#62; 11 e &#60; 30&#58; enfermedad leve&#59; PCDAI &#8804; 10&#58; remisi&#243;n cl&#237;nica&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">DE&#58; desviaci&#243;n est&#225;ndar&#59; PCDAI&#58; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t"></td><td class="td" title="\n
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                  \t\t\t\t">Puntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">1&#46; Historia cl&#237;nica &#40;recuerdo de una semana&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor abdominal</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
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                  \t\t\t\t">Ninguno</td><td class="td" title="\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Leve&#44; de corta duraci&#243;n&#44; no interfiere con la actividad normal</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Intenso&#44; de larga duraci&#243;n&#44; afecta a la actividad normal&#44; nocturno</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Deposiciones &#40;por d&#237;a&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0-1 deposiciones l&#237;quidas&#44; con ausencia de sangre</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hasta 2 deposiciones semiblandas con sangre o 2&#8211;5 deposiciones l&#237;quidas</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sangrado abundante o &#62; 6 deposiciones l&#237;quidas o diarrea nocturna</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estado general y capacidad funcional</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bueno&#46; Actividad no limitada</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Regular&#46; Dificultades ocasionales para mantener las actividades habituales</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Muy deficiente&#46; Limitaciones frecuentes de las actividades</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">2&#46; Anal&#237;tica</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Velocidad de sedimentaci&#243;n globular &#40;mm&#47;h&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 20</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20-50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 50</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Alb&#250;mina &#40;g&#47;l&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 35</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31-34</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 30</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hematocrito &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; <span class="elsevierStyleItalic">10 anos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Var&#243;n 11-14 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Var&#243;n 15&#8211;19 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mujer 11&#8211;19 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#8211;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#8211;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#8211;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#8211;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">3&#46; Exploraci&#243;n</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Peso</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento de peso&#44; peso estable voluntario o adelgazamiento</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Peso estable involuntario&#44; adelgazamiento del 1 al 9 &#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adelgazamiento &#62; 10 &#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Abdomen</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No se observan masas abdominales ni dolor con la palpaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor con la palpaci&#243;n o masas abdominales sin dolor con la palpaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dolor con la palpaci&#243;n&#44; contractura abdominal o masa abdominal definida</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Talla &#40;completar s&#243;lo en el momento del diagn&#243;stico&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n de menos de 1 escala &#40;1 escala &#61; 2 percentiles&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n de 1 a 2 escalas</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disminuci&#243;n de m&#225;s de 2 escalas</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Talla &#40;completar s&#243;lo durante el seguimiento&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Velocidad de crecimiento &#62; &#8212;1 DE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Velocidad de crecimiento &#60; &#8212;1 DE o &#62; &#8212;2 DE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Velocidad de crecimiento &#62; &#8212;2 DE</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Enfermedad perirrectal</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero de colgajos o papilomas cut&#225;neos asintom&#225;ticos</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1-2 f&#237;stulas indoloras&#44; drenaje&#44; sin dolor con la palpaci&#243;n</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#237;stulas activas&#44; drenaje&#44; dolor con la palpaci&#243;n o absceso</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Manifestaciones extraintestinales</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 o m&#225;s</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">&#205;ndice de actividad de la enfermedad de Crohn en ni&#241;os &#40;PCDAI&#41;<a class="elsevierStyleCrossRef" href="#bb0070"><span class="elsevierStyleSup">14</span></a></p>"
        ]
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          "leyenda" => "<p id="sp0050" class="elsevierStyleSimplePara elsevierViewall">CF&#58; calprotectina fecal &#40;a las 0&#44; 4 y 8 semanas de tratamiento&#41;&#59; PCDAI&#58; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fenotipo<a class="elsevierStyleCrossRef" href="#tf0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CF 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CF 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CF 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 a&#241;os y 8 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L3B1A1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Referencia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">R<a class="elsevierStyleCrossRef" href="#tf0025">&#42;&#42;</a> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Sanderson &#40;1987&#41;<a class="elsevierStyleCrossRef" href="#bb0120"><span class="elsevierStyleSup">24</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Ruuska &#40;1993&#41;<a class="elsevierStyleCrossRef" href="#bb0125"><span class="elsevierStyleSup">25</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Thomas &#40;1993&#41;<a class="elsevierStyleCrossRef" href="#bb0130"><span class="elsevierStyleSup">26</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="right" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">DAIS &#62; 80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Papadopoulou &#40;1995&#41;<a class="elsevierStyleCrossRef" href="#bb0135"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">DAIS &#62; 80 &#43; ausencia de s&#237;ntomas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Akobeng &#40;2000&#41;<a class="elsevierStyleCrossRef" href="#bb0100"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PCDAI &#60; 10 o &#8595; 45 &#37; o &#8595; 15 puntos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Day &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0160"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">PCDAI &#60; 15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Borrelli &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0165"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Johnson &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0170"><span class="elsevierStyleSup">34</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Berni Canani &#40;2006&#41;<a class="elsevierStyleCrossRef" href="#bb0175"><span class="elsevierStyleSup">35</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Semielemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rodrigues &#40;2007&#41;<a class="elsevierStyleCrossRef" href="#bb0180"><span class="elsevierStyleSup">36</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Elemental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No especificados<a class="elsevierStyleCrossRef" href="#tf0030">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No especificados<a class="elsevierStyleCrossRef" href="#tf0030">&#42;&#42;&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Navas &#40;2008&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Polim&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PCDAI &#60; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="right" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab192471.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tf0020"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="np0020">An&#225;lisis por protocolo&#59;</p>"
            ]
            1 => array:3 [
              "identificador" => "tf0025"
              "etiqueta" => "&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="np0025">an&#225;lisis por intenci&#243;n de tratar&#59;</p>"
            ]
            2 => array:3 [
              "identificador" => "tf0030"
              "etiqueta" => "&#42;&#42;&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="np0030">informaci&#243;n obtenida del autor&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="sp0065" class="elsevierStyleSimplePara elsevierViewall">Tasa de remisi&#243;n cl&#237;nica en ni&#241;os con enfermedad de Crohn y tratamiento nutricional primario</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "BIBLIOGRAF&#205;A"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0005"
          "bibliografiaReferencia" => array:41 [
            0 => array:3 [
              "identificador" => "bb0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of inflammatory bowel disease in Spain&#46; A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Pajares"
                            1 => "J&#46;P&#46; Gisbert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Enferm Dig"
                        "fecha" => "2001"
                        "volumen" => "93"
                        "paginaInicial" => "9"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11488104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bb0010"
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Información del artículo
ISSN: 16954033
Idioma original: Español
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2018 Septiembre 73 8 81
2018 Agosto 2 0 2
2018 Julio 3 0 3
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2018 Marzo 56 0 56
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2008 Diciembre 4485 0 4485
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