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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La enfermedad de Crohn &#40;EC&#41; es un trastorno inflamatorio cr&#243;nico idiop&#225;tico&#46; Su curso natural se caracteriza por brotes de actividad que alternan con per&#237;odos de remisi&#243;n&#46; El control de la inflamaci&#243;n intestinal es crucial para prevenir la progresi&#243;n del da&#241;o intestinal y el desarrollo de posibles complicaciones<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La incidencia de la EC en la infancia y la adolescencia es aproximadamente de 3 casos por cada 100&#46;000 habitantes &#40;rango&#44; 1-8&#47;100&#46;000 habitantes&#41;&#44; y en la &#250;ltima d&#233;cada ha aumentado tanto en Espa&#241;a como en el resto de Europa<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a>&#46; Hasta un 20&#37; de los casos de EC se diagnostican antes de los 18 a&#241;os de edad&#46; Los casos en ni&#241;os y en adultos difieren en el inicio de la enfermedad&#44; su curso natural y los reg&#237;menes de tratamiento&#46; Otra diferencia importante es el retraso del crecimiento&#44; ya que hasta el 46&#37; de los ni&#241;os y adolescentes diagnosticados de EC presentan una disminuci&#243;n de la velocidad de crecimiento previo al comienzo de cualquier otra sintomatolog&#237;a&#44; y solo el 12&#37; tiene una velocidad de crecimiento normal al diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Esto no solo se observa en el momento del diagn&#243;stico&#44; sino que tambi&#233;n tiene una prevalencia variable durante el seguimiento<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Tambi&#233;n ha de tenerse en cuenta que la aparici&#243;n de enfermedades cr&#243;nicas durante la infancia va asociada a una morbilidad psicol&#243;gica considerable susceptible de afectar a las relaciones personales&#44; el desarrollo puberal&#44; el rendimiento acad&#233;mico y el cumplimiento del tratamiento&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Hay un amplio abanico de objetivos terap&#233;uticos a conseguir&#44; entre los que se incluyen controlar la inflamaci&#243;n&#44; curar la mucosa&#44; alterar la progresi&#243;n de la enfermedad&#44; prevenir los efectos adversos del tratamiento y garantizar un crecimiento y un desarrollo adecuados<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Se ha comprobado que la nutrici&#243;n enteral exclusiva &#40;NEE&#41; es m&#225;s efectiva que los esteroides &#8212;y sin los efectos secundarios de estos&#8212; para lograr la remisi&#243;n mucosa y transmural&#44; un estado asociado a una evoluci&#243;n m&#225;s favorable en los a&#241;os siguientes&#44; una menor tasa de hospitalizaci&#243;n y un uso menos frecuente de f&#225;rmacos biol&#243;gicos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7-11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La calprotectina es una prote&#237;na fijadora de calcio que posee propiedades antimicriobianas&#46; La calprotectina fecal es liberada del citroplasma de los neutr&#243;filos activados y sus niveles en heces aumentan durante la inflamaci&#243;n intestinal<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Los niveles de calprotectina fecal &#40;CF&#41; se correlacionan con los &#237;ndices endosc&#243;picos de adultos y ni&#241;os diagnosticados de enfermedad inflamatoria intestinal &#40;EII&#41;&#46; Se trata de un marcador biol&#243;gico no invasivo y con una elevada sensibilidad y especificidad&#44; que permite monitorizar la actividad inflamatoria y predecir la reca&#237;da cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12-17</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objetivos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Los objetivos del presente estudio fueron determinar la eficacia de la NEE para inducir la remisi&#243;n cl&#237;nica en pacientes diagnosticados de EC y para mejorar el grado de inflamaci&#243;n mucosa utilizando como marcador no invasivo la CF y evaluar la eficacia del tratamiento concomitante&#46; Otro objetivo fue conocer si la introducci&#243;n precoz del tratamiento con tiopur&#237;nicos &#40;antes de las 8 semanas&#41; mejoraba la evoluci&#243;n a largo plazo en comparaci&#243;n con su introducci&#243;n tras la reca&#237;da cl&#237;nica&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Materiales y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio retrospectivo observacional en el que se incluyeron los pacientes menores de 14 a&#241;os diagnosticados de EC y que recibieron nutrici&#243;n enteral exclusiva durante su primer brote de enfermedad&#46; El diagn&#243;stico de EC se realiz&#243; atendiendo a criterios cl&#237;nicos&#44; endosc&#243;picos&#44; histol&#243;gicos y radiol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Quedaron excluidos los pacientes diagnosticados de colitis ulcerosa&#44; colitis indeterminada&#44; colitis eosinof&#237;lica o colitis infecciosa&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Todos los pacientes recibieron f&#243;rmula polim&#233;rica&#44; Modulen IBD<span class="elsevierStyleSup">&#174;</span> o Resource IBD<span class="elsevierStyleSup">&#174;</span> &#40;un mismo producto comercializado con nombres diferentes&#41;&#44; que se prepararon de igual modo mezclando 1&#46;700<span class="elsevierStyleHsp" style=""></span>ml de agua con 400<span class="elsevierStyleHsp" style=""></span>g de producto&#44; lo que daba lugar a 2&#46;000<span class="elsevierStyleHsp" style=""></span>ml de f&#243;rmula &#40;1<span class="elsevierStyleHsp" style=""></span>kcal&#47;ml&#41;&#46; El volumen a administrar se calcul&#243; empleando la f&#243;rmula de Schofield&#44; que estima el gasto energ&#233;tico basal<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Las tomas se incrementaron gradualmente hasta alcanzar el volumen pautado en 3-5 d&#237;as y solo se permiti&#243; la ingesta de agua durante el tratamiento&#46; La NEE se administr&#243; durante un per&#237;odo de 6 a 8 semanas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los datos recogidos fueron edad&#44; sexo&#44; antecedentes familiares de EII&#44; tiempo transcurrido desde el diagn&#243;stico y el tratamiento farmacol&#243;gico concomitante&#46; El fenotipo de la EC se estableci&#243; atendiendo a la clasificaci&#243;n de Par&#237;s<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Se evalu&#243; a todos los pacientes al comienzo y al final del per&#237;odo de NEE&#44; las variables que se analizaron fueron peso&#44; talla&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; prote&#237;na C reactiva &#40;PCR&#41;&#44; velocidad de sedimentaci&#243;n globular &#40;VSG&#41;&#44; alb&#250;mina&#44; hemograma&#44; CF &#40;Calprest<span class="elsevierStyleSup">&#174;</span>&#44; Eurospital&#44; Italia&#41; y el &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica &#40;PCDAI&#41;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46; El peso y la talla se midieron con el paciente descalzo y en ropa interior&#46; Las muestras para la determinaci&#243;n de la CF fueron tomadas por el paciente en su domicilio el d&#237;a antes de la prueba y se entregaron refrigeradas al laboratorio para su an&#225;lisis inmediato&#46; La remisi&#243;n cl&#237;nica se defini&#243; como un PCDAI &#60; 10 y la respuesta cl&#237;nica como un cambio de m&#225;s de 12&#44;5 puntos sobre el PCDAI basal tras 6-8 semanas de NEE&#46; Los niveles de CF se consideraron normales si se encontraban por debajo de los 50<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g de heces&#46; Las puntuaciones Z del peso&#44; talla e IMC se calcularon utilizando los datos del Estudio Espa&#241;ol del Crecimiento<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables que segu&#237;an una distribuci&#243;n normal se expresaron como media &#177; desviaci&#243;n est&#225;ndar y las variables con distribuciones no normales como mediana y rango intercuart&#237;lico &#40;RIC&#41;&#46; La normalidad de la distribuci&#243;n de los datos se comprob&#243; mediante la prueba de Kolmogorov-Smirnov&#46; Se utilizaron la prueba de la t de Student y la prueba de los rangos con signo de Wilcoxon para muestras pareadas&#44; y la prueba de Chi cuadrado para comparar proporciones&#46; Para comparar los niveles de CF en relaci&#243;n con el PCDAI se aplic&#243; el test no param&#233;trico de Kruskal Wallis y si se rechazaba la hip&#243;tesis de igualdad&#44; para ver que grupos difieren entre s&#237;&#44; se compararon 2 a 2 mediante la prueba de Mann Whitney con la correcci&#243;n de Bonferroni&#46; El an&#225;lisis de supervivencia se realiz&#243; mediante el m&#233;todo de Kaplan-Meier&#46; Las curvas de supervivencia se compararon mediante la prueba de log rank&#46; El nivel de significaci&#243;n estad&#237;stica se estableci&#243; en p &#60; 0&#44;05&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas de los pacientes</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se incluy&#243; a 40 pacientes&#59; 24 eran varones &#40;60&#37;&#41; con una edad al diagn&#243;stico de 11&#44;6 &#177; 3&#44;6 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Seis pacientes ten&#237;an antecedentes familiares de EII &#40;EC en 4 y colitis ulcerosa en 2&#41;&#46; El tiempo transcurrido desde la aparici&#243;n de s&#237;ntomas hasta el diagn&#243;stico fue de 4&#44;2 meses &#40;RIC 2&#44;3-12&#44;1&#41;&#44; siendo ligeramente menor en los pacientes con historia familiar de EII &#40;4&#44;7 meses &#91;RIC 2&#44;4-12&#44;2&#93; vs&#46; 3&#44;5 meses &#91;RIC 1&#44;4-8&#44;5&#93;&#44; p &#61; 0&#44;394&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Calprotectina fecal</span><p id="par0055" class="elsevierStylePara elsevierViewall">El nivel basal de CF fue de 680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;RIC 524-796&#41; y descendi&#243; significativamente a 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;RIC 149-402&#59; p &#60; 0&#44;0001&#41; tras la NEE&#46; Encontramos una correlaci&#243;n estrecha &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; entre la CF y el PCDAI &#40;rho &#61; 0&#44;727&#59; p &#60; 0&#44;0001&#41;&#46; La CF fue significativamente m&#225;s alta &#40;p &#61; 0&#44;04&#41; en pacientes con enfermedad moderada y grave &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Combinaci&#243;n de nutrici&#243;n enteral exclusiva con tratamiento farmacol&#243;gico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Al inicio de la NEE&#44; los pacientes estaban recibiendo mesalazina &#40;32&#44;5&#37;&#41;&#44; metronidazol &#40;17&#44;5&#37;&#41; o ambos &#40;45&#37;&#41; como tratamiento concomitante &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Una vez se hubo revisado y optimizado su calendario de vacunaciones&#44; 27 de los 40 pacientes &#40;67&#44;5&#37;&#41; iniciaron tratamiento con azatioprina con dosis de entre 2&#44;5 y 3&#44;0<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; en una mediana de 9 d&#237;as &#40;RIC 0-19&#41;&#46; En 2 casos fue preciso suspender la azatioprina&#44; en uno por intolerancia &#40;dolor abdominal y n&#225;useas&#41; y en otro por pancreatitis&#59; en ambos pacientes se cambi&#243; a 6-mercaptopurina sin incidencias&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Respuesta a la nutrici&#243;n enteral exclusiva</span><p id="par0065" class="elsevierStylePara elsevierViewall">Seis pacientes no completaron las 6-8 semanas de NEE&#59; 2 decidieron abandonarla tras 2 semanas y otros 4 recibieron esteroides tras 3 semanas de NEE al no constatarse respuesta&#46; La NEE se administr&#243; por v&#237;a oral&#44; salvo en un paciente&#44; que requiri&#243; sonda nasog&#225;strica&#46; La duraci&#243;n de la NEE fue de 6&#44;4 semanas &#40;RIC 6-8&#44;1&#41;&#46; De los 34 pacientes que completaron el per&#237;odo de NEE&#44; 32 &#40;94&#37; en el an&#225;lisis por protocolo&#41; alcanzaron la remisi&#243;n cl&#237;nica&#46; Este porcentaje descendi&#243; al 80&#37; en el an&#225;lisis por intenci&#243;n de tratar&#46; La tasa de cumplimiento fue del 95&#37;&#46; Se observ&#243; un aumento significativo en el peso&#44; niveles de alb&#250;mina&#44; hemoglobina y hematocrito junto con un descenso significativo de la CF&#44; PCR&#44; VSG&#44; leucocitos y plaquetas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; al final de la NEE&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los pacientes toleraron bien la NEE y no hubo ninguno que declarara haber experimentado efecto secundario alguno durante este per&#237;odo&#46; Al finalizar la NEE&#44; se introdujeron progresivamente los diferentes grupos de alimentos sin incidencias&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">No se apreciaron diferencias significativas en la tasa de respuesta en relaci&#243;n a la gravedad del brote seg&#250;n el PCDAI<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> &#40;91&#37; vs&#46; 76&#37;&#44; p &#61; 0&#44;136&#41;&#44; aunque s&#237; se encontraron diferencias en la respuesta al aplicar los nuevos puntos de corte del PCDAI<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> &#40;90&#37; en EC leve&#44; 100&#37; en EC moderada y 68&#44;2&#37; en EC grave&#59; p &#61; 0&#44;05&#41;&#46; Tambi&#233;n se hallaron diferencias estad&#237;sticamente significativas en relaci&#243;n con la localizaci&#243;n de la EC &#40;88&#37; para L1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L3 vs&#46; 50&#37; para L2&#59; p &#61; 0&#44;047&#41;&#44; si bien solo 5 pacientes tuvieron una localizaci&#243;n L2 de la EC&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Seguimiento</span><p id="par0080" class="elsevierStylePara elsevierViewall">Diecinueve de los 32 pacientes &#40;59&#44;4&#37;&#41; que alcanzaron la remisi&#243;n cl&#237;nica hab&#237;an comenzado tratamiento precoz &#40;&#8804; 8 semanas despu&#233;s de iniciar la NEE&#41; con azatioprina &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Al final del periodo de seguimiento &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; 5 pacientes &#40;26&#44;3&#37;&#41; tratados con azatioprina como terapia de mantenimiento y 2&#40;15&#44;3&#37;&#41; que no hab&#237;an recibido tratamiento de mantenimiento continuaban en remisi&#243;n &#40;diferencia del 11&#37;&#59; intervalo de confianza &#91;IC&#93; del 95&#37;&#44;&#8722;3&#44;13&#37; a 25&#44;13&#37;&#59; p &#61; 0&#44;389&#41;&#46; No se detectaron diferencias entre grupos en el tiempo transcurrido hasta la reca&#237;da &#40;8&#44;1 meses &#91;RIC 3&#46;18&#93; en el grupo de azatioprina precoz vs&#46; 10 meses &#91;2&#44;6-24&#44;6&#93; en el grupo de azatioprina tard&#237;a&#59; p &#61; 0&#44;954&#41;&#46; La duraci&#243;n mediana del per&#237;odo de seguimiento fue de 2&#44;9 a&#241;os &#40;RIC 1&#44;8-4&#44;8&#41; para ambos grupos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nuestro estudio muestra que la NEE induce la remisi&#243;n cl&#237;nica y bioqu&#237;mica&#44; y la recuperaci&#243;n de peso en pacientes con nuevo diagn&#243;stico de EC&#46; Aunque no se realiz&#243; una endoscopia al finalizar la NEE&#44; la marcada reducci&#243;n en la CF indica una clara mejor&#237;a en el grado de inflamaci&#243;n de la mucosa intestinal<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12-15</span></a>&#46; La tasa de curaci&#243;n mucosa alcanzada con la NEE es similar&#44; en muchos casos&#44; a la obtenida por los anti-TNF&#44; y mayor que con los esteroides<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9-11&#44;24-26</span></a>&#46; Las publicaciones que argumentan estos resultados pueden estar sesgadas ya que es mucho m&#225;s probable que la NEE se administre en pacientes al debut o con enfermedad leve-moderada a diferencia de lo que ocurre con los esteroides o anti-TNF&#44; reservados para casos graves o con mayor tiempo de evoluci&#243;n&#46; No obstante&#44; al contrario que los esteroides&#44; la NEE tiene un efecto positivo sobre el crecimiento lineal&#44; con un incremento en la velocidad de crecimiento y en la densidad mineral &#243;sea en los 6 meses posteriores al inicio de la NEE<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27-30</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En un estudio reciente de 34 pacientes<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; el 58&#37; de los pacientes tratados con NEE alcanzaron la remisi&#243;n endosc&#243;pica &#40;evaluada mediante el &#237;ndice SES-CD<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#41; y el 21&#37; alcanz&#243; la remisi&#243;n transmural&#44; evaluada por medio de entero-resonancia magn&#233;tica&#46; Los autores demostraron que la remisi&#243;n endosc&#243;pica precoz se asociaba a tasas menores de reca&#237;da endosc&#243;pica&#44; a un uso menor de la terapia anti-TNF-&#945; y a un n&#250;mero menor de ingresos un a&#241;o despu&#233;s del diagn&#243;stico&#46; La respuesta fue m&#225;s favorable en pacientes con diagn&#243;sticos m&#225;s recientes&#46; El mismo estudio muestra que la inducci&#243;n de la remisi&#243;n con esteroides en lugar de con la NEE aumenta el riesgo de falta o p&#233;rdida de respuesta a la terapia anti-TNF-&#945;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La eficacia de la NEE se observ&#243; por primera vez al comienzo de los a&#241;os 70&#44; cuando se descubri&#243; que el estado cl&#237;nico y nutricional de algunos pacientes hab&#237;a mejorado con el tratamiento con una f&#243;rmula elemental mientras esperaban a ser operados&#46; Aunque se desconocen los mecanismos de acci&#243;n de la NEE&#44; existen varias hip&#243;tesis al respecto&#44; como la modificaci&#243;n de 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 debido a una reducci&#243;n de la cantidad de grasa en la dieta o el aporte de micronutrientes al intestino inflamado<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Un an&#225;lisis de los datos de m&#225;s de 25 estudios pedi&#225;tricos muestra que la eficacia global de la NEE es del 84&#37; &#40;IC del 95&#37;&#44; 81&#37;-87&#37;&#41;&#44; si bien los estudios difer&#237;an en las f&#243;rmulas enterales utilizadas&#44; los criterios de remisi&#243;n cl&#237;nica y la duraci&#243;n del tratamiento&#46; La tasa de cumplimiento es muy alta&#44; alcanzando el 90&#37; &#40;IC del 95&#37;&#44; 88&#37;-92&#37;&#41;&#46; No se han encontrado diferencias en las tasas de remisi&#243;n o de cumplimiento en relaci&#243;n con la f&#243;rmula enteral utilizada &#40;polim&#233;rica&#44; semielemental o elemental&#41; ni con suplementos de glutamina o de triglic&#233;ridos de cadena media<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; En nuestra serie solo se emple&#243; un tipo de f&#243;rmula espec&#237;fica para la EC enriquecida con TGF-&#946;&#44; no permiti&#233;ndose la ingesta de ning&#250;n otro alimento&#44; salvo agua durante el per&#237;odo de NEE&#46; La nutrici&#243;n enteral parcial &#40;con el 50&#37; de las calor&#237;as provenientes de una dieta normal&#41; ha demostrado ser menos efectiva que la NEE<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46; Otras modalidades&#44; como permitir que un 20&#37; de las calor&#237;as diarias estimadas proviniesen de otros alimentos&#44; no han mostrado una eficacia menor<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En un primer momento se pens&#243; que la terapia nutricional era m&#225;s efectiva en pacientes con afectaci&#243;n ileal que en aquellos con afectaci&#243;n exclusivamente col&#243;nica&#46; Actualmente&#44; no se dispone de datos para establecer una correlaci&#243;n entre la respuesta a la NEE y el fenotipo de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46; Hemos de a&#241;adir que en nuestra serie se apreciaron diferencias significativas en relaci&#243;n con la localizaci&#243;n&#44; aunque el n&#250;mero de pacientes con afectaci&#243;n exclusivamente col&#243;nica fue muy reducido&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Si bien nuestro estudio no fue dise&#241;ado para analizar el impacto del tratamiento precoz con tiopurinas en la evoluci&#243;n de la enfermedad tras la inducci&#243;n de la remisi&#243;n&#44; se observ&#243; que&#44; aunque no hubo diferencias en el mantenimiento de la remisi&#243;n entre pacientes con tratamiento precoz &#40;&#8804; 8 semanas&#41; y con tratamiento tard&#237;o &#40;&#62; 8 semanas&#41; &#40;v&#233;ase la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; los pacientes tratados precozmente requirieron menos esteroides durante el seguimiento &#40;p &#61; 0&#44;001&#41;&#46; Nuestros resultados concuerdan con los de otros estudios realizados tanto en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;37</span></a> como adultos<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a> y difieren de los resultados publicados por Markovitz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">40</span></a> Es posible que esta discrepancia entre estudios pedi&#225;tricos se deba&#44; en parte&#44; a que ninguno de los pacientes en el estudio de Markovitz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">40</span></a> fue tratado con NEE para inducir la remisi&#243;n&#44; ya que es sabido que es poco probable conseguir la curaci&#243;n de la mucosa mediante el tratamiento con esteroides&#46; Se requieren m&#225;s estudios para establecer recomendaciones sobre el momento &#243;ptimo del inicio del tratamiento con inmunomoduladores en la EC pedi&#225;trica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Este estudio ofrece informaci&#243;n valiosa sobre la eficacia de la NEE en la EC pedi&#225;trica&#46; La limitaci&#243;n m&#225;s importante es el n&#250;mero reducido de pacientes&#44; que probablemente lleva a subestimar el efecto de las tiopurinas en el an&#225;lisis retrospectivo de los datos&#44; y que dificulta la obtenci&#243;n de informaci&#243;n m&#225;s consistente&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la administraci&#243;n de NEE durante 6-8 semanas es efectiva en la inducci&#243;n de la remisi&#243;n cl&#237;nica y bioqu&#237;mica&#44; mejorar los par&#225;metros antropom&#233;tricos y reducir el grado de inflamaci&#243;n de la mucosa intestinal&#46; La CF permite monitorizar la respuesta a la NEE y el control del grado de inflamaci&#243;n de la mucosa&#46; Los pacientes tratados precozmente con tiopurinas recibieron menos esteroides durante el seguimiento&#46; El per&#237;odo de NEE es clave para la actualizaci&#243;n del calendario vacunal y para la solicitud de las pruebas complementarias necesarias antes de comenzar el tratamiento inmunosupresor&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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              "titulo" => "Calprotectina fecal"
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              "titulo" => "Combinaci&#243;n de nutrici&#243;n enteral exclusiva con tratamiento farmacol&#243;gico"
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              "titulo" => "Respuesta a la nutrici&#243;n enteral exclusiva"
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            0 => "Inflammatory bowel disease"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La nutrici&#243;n enteral exclusiva &#40;NEE&#41; ha demostrado ser m&#225;s efectiva que los esteroides para alcanzar la curaci&#243;n mucosa sin sus efectos secundarios&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar la eficacia de la NEE para inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n mucosa en pacientes con EC durante su primer brote&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n de las historias cl&#237;nicas de pacientes con EC tratados con NEE durante su primer brote&#46; El grado de inflamaci&#243;n mucosa se estim&#243; mediante la calprotectina fecal &#40;CF&#41;&#46; Se defini&#243; remisi&#243;n como PCDAI &#60; 10&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 40 pacientes &#40;24 varones&#41; con una edad al diagn&#243;stico de 11&#44;6 &#177; 3&#44;6 a&#241;os&#46; La duraci&#243;n de la NEE fue de 6&#44;42 semanas &#40;RIC 6&#44;0-8&#44;14&#41;&#46; De los 34 pacientes que completaron el per&#237;odo de NEE&#44; 32 &#40;94&#37; en el an&#225;lisis por protocolo&#41; alcanzaron la remisi&#243;n cl&#237;nica&#46; Este porcentaje descendi&#243; al 80&#37; en el an&#225;lisis por intenci&#243;n de tratar&#46; La tasa de cumplimiento fue del 95&#37;&#46; Los valores de CF fueron significativamente m&#225;s altos en pacientes con brotes moderados y graves&#46; La CF basal fue de 680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g y descendi&#243; de forma significativa a 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g al final del periodo de NEE &#40;p &#60; 0&#44;0001&#41;&#46; Hubo correlaci&#243;n estad&#237;sticamente significativa entre CF y PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;727&#59; p &#60; 0&#44;0001&#41;&#46; La introducci&#243;n precoz del tratamiento con tiopurinas &#40;antes de las 8 semanas&#41; no se asoci&#243; a una mejor evoluci&#243;n durante el seguimiento&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La NEE administrada durante 6-8 semanas es efectiva para inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n mucosa&#46; No encontramos diferencias en t&#233;rminos de mantenimiento de la remisi&#243;n en pacientes tratados precozmente con tiopurinas&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Exclusive enteral nutrition &#40;EEN&#41; has been to be more effective than corticosteroids in achieving mucosal healing without their side effects&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materials and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The medical records of patients with newly diagnosed Crohn&#39;s disease treated with EEN were reviewed retrospectively&#46; The degree of mucosal inflammation was assessed by fecal calprotectin &#40;FC&#41;&#46; Remission was defined as a PCDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Forty patients &#40;24 males&#41; were included&#44; the age at diagnosis was 11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 years&#46; Of the 34 patients who completed the EEN period&#44; 32 &#40;94&#37; per-protocol analysis&#41; achieved clinical remission&#46; This percentage fell to 80&#37; in the intention-to-treat analysis&#46; The compliance rate was 95&#37;&#46; Duration of EEN was 6&#46;42 weeks &#40;IQR 6&#46;0&#8211;8&#46;14&#41;&#46; FC was significantly higher in patients with moderate and severe disease&#46; Median baseline FC levels &#40;680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g&#41; decreased significantly to 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g <span class="elsevierStyleItalic">&#40;P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; after EEN&#46; We found a statistically significant correlation between FC and PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;727&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Early use of thiopurines &#40;&#60; 8 weeks&#41; versus subsequent use was not associated with improved outcomes during the follow-up&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">EEN administered for 6-8 weeks is effective for inducing clinical remission and decreasing the degree of mucosal inflammation&#46; We did not find differences in terms of maintenance of remission in patients treated early with thiopurines&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Clasificaci&#243;n de Par&#237;s</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4 &#40;extensa&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;32&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;97&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perianal &#40;p&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;32&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retraso del crecimiento &#40;G1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;27&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCDAI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCDAI<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PCDAI<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;27&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Moderado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleSup">&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Grave&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;72&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Tratamiento al inicio de la NEE</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-ASA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;32&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metronidazol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;17&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-ASA y metronidazol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Metronidazol y azitromicina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ninguno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "identificador" => "tblfn0005"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Remisi&#243;n &#8804; 10&#59; leve 11-30&#59; moderado a grave<span class="elsevierStyleSup">&#42;</span> &#62; 30 puntos&#46; Adaptado de Hyams et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p>"
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            1 => array:3 [
              "identificador" => "tblfn0010"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Remisi&#243;n &#60; 10&#59; leve 10-2 7&#44;5&#59; moderado 30-37&#44;5&#59; grave &#62; 37&#44;5 puntos&#46; Adaptado de Turner et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p>"
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes tratados con nutrici&#243;n enteral exclusiva</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CF&#58; calprotectina fecal&#59; NEE&#58; nutrici&#243;n enteral exclusiva&#59; IMC&#58; &#237;ndice de masa corporal&#59; PCDAI&#58; &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica&#59; PCR&#58; prote&#237;na C reactiva&#59; RIC&#58; rango intercuart&#237;lico&#59; VSG&#58; velocidad de sedimentaci&#243;n globular&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Antes de la NEE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Despu&#233;s de la NEE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Peso&#44; puntuaci&#243;n Z media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Talla&#44; puntuaci&#243;n Z media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;275&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">IMC&#44; puntuaci&#243;n Z media&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PCDAI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;RIC 28-47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;RIC 0-5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">CF &#40;&#956;g&#47;g&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">680 &#40;RIC 524-796&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">218 &#40;RIC 149-402&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">PCR &#40;mg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;9 &#40;RIC 16&#44;5-67&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1 &#40;RIC 2&#44;4-9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VSG &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;RIC 21&#44;5-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;RIC 7-16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alb&#250;mina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;2 &#40;RIC 2&#44;7-3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;1 &#40;RIC 3&#44;7-4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;4 &#40;RIC 9&#44;9-12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;8 &#40;RIC 11&#44;5-13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hematocrito &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;2 &#40;RIC 31&#44;7-37&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;RIC 35-39&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Leucocitos &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;6 &#177; 3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;7 &#177; 2&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Plaquetas &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">533 &#177; 140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">443 &#177; 150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento precoz con IM &#40;&#8804; 8 semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento posterior con IM &#40;&#62; 8 semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de pacientes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad al diagn&#243;stico &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;9 &#177; 2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;9 &#177; 3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo de evoluci&#243;n al diagn&#243;stico &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;4 &#40;RIC 3&#44;7-12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;5 &#40;RIC 1&#44;4-4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;19 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;530&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;19 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;13 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#47;19 &#40;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;13 &#40;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L4a o L4b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;19 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Retraso del crecimiento</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;19 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;13 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Afectaci&#243;n perianal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;19 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;13 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">IMC&#44; mediana &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;7 &#40;RIC 15&#44;4-18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;RIC 14-19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCDAI&#44; mediana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;RIC 27&#44;5-42&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;RIC 30-46&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CF&#44; media &#40;&#956;g&#47;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">680 &#177; 154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596 &#177; 210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;326&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCR&#44; mediana &#40;mg&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;RIC 16-47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;RIC 23-85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">VSG&#44; mediana &#40;mm&#47;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;RIC 20&#44;7-39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;RIC 22-62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Alb&#250;mina&#44; mediana &#40;g&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;3 &#40;RIC 2&#44;9-3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;RIC 2&#44;4-3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Plaquetas&#44; media &#40;&#215;103&#47;&#956;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">506 &#177; 107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">547 &#177; 149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;735&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Niveles altos de TPMT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;13 &#40;84&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;6 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Niveles intermedios de TPMT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;6 &#40;33&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Seguimiento</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tiempo hasta la reca&#237;da &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;1 &#40;RIC 3-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;RIC 2&#44;6-24&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;954&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tasa de reca&#237;da a los 12 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;19 &#40;47&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;13 &#40;53&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;719&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tasa de reca&#237;da a los 18 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;7 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;5 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tasa de reca&#237;da a los 24 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;6 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;4 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;429&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Seguimiento medio &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;83 &#40;RIC 1&#44;1-4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;57 &#40;RIC 1&#44;8-5&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;343&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Suplementaci&#243;n con f&#243;rmula enteral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#47;19 &#40;94&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#47;13 &#40;92&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;613&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Duraci&#243;n de la suplementaci&#243;n &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;RIC 6&#44;9-22&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;7 &#40;RIC 3&#44;5-66&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tratamiento con prednisona durante el seguimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;19 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;13 &#40;84&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cambio de patr&#243;n cl&#237;nico en la EC &#40;B1 a B2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;406&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tratamiento con IFX o ADA durante el seguimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;19 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;13 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;473&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;8 &#40;RIC 3-23&#41;&nbsp;\t\t\t\t\t\t\n
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ORIGINAL
La nutrición enteral exclusiva continua siendo el tratamiento de primera línea en la enfermedad de Crohn pediátrica en la era de los biológicos
Exclusive enteral nutrition continues to be first line therapy for pediatric Crohn's disease in the era of biologics
V.M. Navas-Lópeza,b,
Autor para correspondencia
victor.navas@gmail.com

Autor para correspondencia.
, J. Blasco-Alonsoa,b, S. Lacasa Maseria, F. Girón Fernández-Crehueta, M.J. Serrano Nietoa, M.I. Vicioso Recioc, C. Sierra Salinasa,b
a Unidad de Gastroenterología y Nutrición Infantil. Hospital Materno Infantil, Málaga, España
b Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
c Servicio de Laboratorio, Hospital Regional Carlos Haya, Málaga, España
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlaci&#243;n entre la calprotectina fecal y el PCDAI &#40;coeficiente de correlaci&#243;n de Spearman&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La enfermedad de Crohn &#40;EC&#41; es un trastorno inflamatorio cr&#243;nico idiop&#225;tico&#46; Su curso natural se caracteriza por brotes de actividad que alternan con per&#237;odos de remisi&#243;n&#46; El control de la inflamaci&#243;n intestinal es crucial para prevenir la progresi&#243;n del da&#241;o intestinal y el desarrollo de posibles complicaciones<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La incidencia de la EC en la infancia y la adolescencia es aproximadamente de 3 casos por cada 100&#46;000 habitantes &#40;rango&#44; 1-8&#47;100&#46;000 habitantes&#41;&#44; y en la &#250;ltima d&#233;cada ha aumentado tanto en Espa&#241;a como en el resto de Europa<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a>&#46; Hasta un 20&#37; de los casos de EC se diagnostican antes de los 18 a&#241;os de edad&#46; Los casos en ni&#241;os y en adultos difieren en el inicio de la enfermedad&#44; su curso natural y los reg&#237;menes de tratamiento&#46; Otra diferencia importante es el retraso del crecimiento&#44; ya que hasta el 46&#37; de los ni&#241;os y adolescentes diagnosticados de EC presentan una disminuci&#243;n de la velocidad de crecimiento previo al comienzo de cualquier otra sintomatolog&#237;a&#44; y solo el 12&#37; tiene una velocidad de crecimiento normal al diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; Esto no solo se observa en el momento del diagn&#243;stico&#44; sino que tambi&#233;n tiene una prevalencia variable durante el seguimiento<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Tambi&#233;n ha de tenerse en cuenta que la aparici&#243;n de enfermedades cr&#243;nicas durante la infancia va asociada a una morbilidad psicol&#243;gica considerable susceptible de afectar a las relaciones personales&#44; el desarrollo puberal&#44; el rendimiento acad&#233;mico y el cumplimiento del tratamiento&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Hay un amplio abanico de objetivos terap&#233;uticos a conseguir&#44; entre los que se incluyen controlar la inflamaci&#243;n&#44; curar la mucosa&#44; alterar la progresi&#243;n de la enfermedad&#44; prevenir los efectos adversos del tratamiento y garantizar un crecimiento y un desarrollo adecuados<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Se ha comprobado que la nutrici&#243;n enteral exclusiva &#40;NEE&#41; es m&#225;s efectiva que los esteroides &#8212;y sin los efectos secundarios de estos&#8212; para lograr la remisi&#243;n mucosa y transmural&#44; un estado asociado a una evoluci&#243;n m&#225;s favorable en los a&#241;os siguientes&#44; una menor tasa de hospitalizaci&#243;n y un uso menos frecuente de f&#225;rmacos biol&#243;gicos<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7-11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La calprotectina es una prote&#237;na fijadora de calcio que posee propiedades antimicriobianas&#46; La calprotectina fecal es liberada del citroplasma de los neutr&#243;filos activados y sus niveles en heces aumentan durante la inflamaci&#243;n intestinal<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Los niveles de calprotectina fecal &#40;CF&#41; se correlacionan con los &#237;ndices endosc&#243;picos de adultos y ni&#241;os diagnosticados de enfermedad inflamatoria intestinal &#40;EII&#41;&#46; Se trata de un marcador biol&#243;gico no invasivo y con una elevada sensibilidad y especificidad&#44; que permite monitorizar la actividad inflamatoria y predecir la reca&#237;da cl&#237;nica<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12-17</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objetivos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Los objetivos del presente estudio fueron determinar la eficacia de la NEE para inducir la remisi&#243;n cl&#237;nica en pacientes diagnosticados de EC y para mejorar el grado de inflamaci&#243;n mucosa utilizando como marcador no invasivo la CF y evaluar la eficacia del tratamiento concomitante&#46; Otro objetivo fue conocer si la introducci&#243;n precoz del tratamiento con tiopur&#237;nicos &#40;antes de las 8 semanas&#41; mejoraba la evoluci&#243;n a largo plazo en comparaci&#243;n con su introducci&#243;n tras la reca&#237;da cl&#237;nica&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Materiales y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio retrospectivo observacional en el que se incluyeron los pacientes menores de 14 a&#241;os diagnosticados de EC y que recibieron nutrici&#243;n enteral exclusiva durante su primer brote de enfermedad&#46; El diagn&#243;stico de EC se realiz&#243; atendiendo a criterios cl&#237;nicos&#44; endosc&#243;picos&#44; histol&#243;gicos y radiol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46; Quedaron excluidos los pacientes diagnosticados de colitis ulcerosa&#44; colitis indeterminada&#44; colitis eosinof&#237;lica o colitis infecciosa&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Todos los pacientes recibieron f&#243;rmula polim&#233;rica&#44; Modulen IBD<span class="elsevierStyleSup">&#174;</span> o Resource IBD<span class="elsevierStyleSup">&#174;</span> &#40;un mismo producto comercializado con nombres diferentes&#41;&#44; que se prepararon de igual modo mezclando 1&#46;700<span class="elsevierStyleHsp" style=""></span>ml de agua con 400<span class="elsevierStyleHsp" style=""></span>g de producto&#44; lo que daba lugar a 2&#46;000<span class="elsevierStyleHsp" style=""></span>ml de f&#243;rmula &#40;1<span class="elsevierStyleHsp" style=""></span>kcal&#47;ml&#41;&#46; El volumen a administrar se calcul&#243; empleando la f&#243;rmula de Schofield&#44; que estima el gasto energ&#233;tico basal<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#46; Las tomas se incrementaron gradualmente hasta alcanzar el volumen pautado en 3-5 d&#237;as y solo se permiti&#243; la ingesta de agua durante el tratamiento&#46; La NEE se administr&#243; durante un per&#237;odo de 6 a 8 semanas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Los datos recogidos fueron edad&#44; sexo&#44; antecedentes familiares de EII&#44; tiempo transcurrido desde el diagn&#243;stico y el tratamiento farmacol&#243;gico concomitante&#46; El fenotipo de la EC se estableci&#243; atendiendo a la clasificaci&#243;n de Par&#237;s<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Se evalu&#243; a todos los pacientes al comienzo y al final del per&#237;odo de NEE&#44; las variables que se analizaron fueron peso&#44; talla&#44; &#237;ndice de masa corporal &#40;IMC&#41;&#44; prote&#237;na C reactiva &#40;PCR&#41;&#44; velocidad de sedimentaci&#243;n globular &#40;VSG&#41;&#44; alb&#250;mina&#44; hemograma&#44; CF &#40;Calprest<span class="elsevierStyleSup">&#174;</span>&#44; Eurospital&#44; Italia&#41; y el &#237;ndice de actividad de la enfermedad de Crohn pedi&#225;trica &#40;PCDAI&#41;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#46; El peso y la talla se midieron con el paciente descalzo y en ropa interior&#46; Las muestras para la determinaci&#243;n de la CF fueron tomadas por el paciente en su domicilio el d&#237;a antes de la prueba y se entregaron refrigeradas al laboratorio para su an&#225;lisis inmediato&#46; La remisi&#243;n cl&#237;nica se defini&#243; como un PCDAI &#60; 10 y la respuesta cl&#237;nica como un cambio de m&#225;s de 12&#44;5 puntos sobre el PCDAI basal tras 6-8 semanas de NEE&#46; Los niveles de CF se consideraron normales si se encontraban por debajo de los 50<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g de heces&#46; Las puntuaciones Z del peso&#44; talla e IMC se calcularon utilizando los datos del Estudio Espa&#241;ol del Crecimiento<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">An&#225;lisis estad&#237;stico</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las variables que segu&#237;an una distribuci&#243;n normal se expresaron como media &#177; desviaci&#243;n est&#225;ndar y las variables con distribuciones no normales como mediana y rango intercuart&#237;lico &#40;RIC&#41;&#46; La normalidad de la distribuci&#243;n de los datos se comprob&#243; mediante la prueba de Kolmogorov-Smirnov&#46; Se utilizaron la prueba de la t de Student y la prueba de los rangos con signo de Wilcoxon para muestras pareadas&#44; y la prueba de Chi cuadrado para comparar proporciones&#46; Para comparar los niveles de CF en relaci&#243;n con el PCDAI se aplic&#243; el test no param&#233;trico de Kruskal Wallis y si se rechazaba la hip&#243;tesis de igualdad&#44; para ver que grupos difieren entre s&#237;&#44; se compararon 2 a 2 mediante la prueba de Mann Whitney con la correcci&#243;n de Bonferroni&#46; El an&#225;lisis de supervivencia se realiz&#243; mediante el m&#233;todo de Kaplan-Meier&#46; Las curvas de supervivencia se compararon mediante la prueba de log rank&#46; El nivel de significaci&#243;n estad&#237;stica se estableci&#243; en p &#60; 0&#44;05&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Resultados</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Caracter&#237;sticas de los pacientes</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se incluy&#243; a 40 pacientes&#59; 24 eran varones &#40;60&#37;&#41; con una edad al diagn&#243;stico de 11&#44;6 &#177; 3&#44;6 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Seis pacientes ten&#237;an antecedentes familiares de EII &#40;EC en 4 y colitis ulcerosa en 2&#41;&#46; El tiempo transcurrido desde la aparici&#243;n de s&#237;ntomas hasta el diagn&#243;stico fue de 4&#44;2 meses &#40;RIC 2&#44;3-12&#44;1&#41;&#44; siendo ligeramente menor en los pacientes con historia familiar de EII &#40;4&#44;7 meses &#91;RIC 2&#44;4-12&#44;2&#93; vs&#46; 3&#44;5 meses &#91;RIC 1&#44;4-8&#44;5&#93;&#44; p &#61; 0&#44;394&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Calprotectina fecal</span><p id="par0055" class="elsevierStylePara elsevierViewall">El nivel basal de CF fue de 680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;RIC 524-796&#41; y descendi&#243; significativamente a 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g &#40;RIC 149-402&#59; p &#60; 0&#44;0001&#41; tras la NEE&#46; Encontramos una correlaci&#243;n estrecha &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; entre la CF y el PCDAI &#40;rho &#61; 0&#44;727&#59; p &#60; 0&#44;0001&#41;&#46; La CF fue significativamente m&#225;s alta &#40;p &#61; 0&#44;04&#41; en pacientes con enfermedad moderada y grave &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Combinaci&#243;n de nutrici&#243;n enteral exclusiva con tratamiento farmacol&#243;gico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Al inicio de la NEE&#44; los pacientes estaban recibiendo mesalazina &#40;32&#44;5&#37;&#41;&#44; metronidazol &#40;17&#44;5&#37;&#41; o ambos &#40;45&#37;&#41; como tratamiento concomitante &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Una vez se hubo revisado y optimizado su calendario de vacunaciones&#44; 27 de los 40 pacientes &#40;67&#44;5&#37;&#41; iniciaron tratamiento con azatioprina con dosis de entre 2&#44;5 y 3&#44;0<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; en una mediana de 9 d&#237;as &#40;RIC 0-19&#41;&#46; En 2 casos fue preciso suspender la azatioprina&#44; en uno por intolerancia &#40;dolor abdominal y n&#225;useas&#41; y en otro por pancreatitis&#59; en ambos pacientes se cambi&#243; a 6-mercaptopurina sin incidencias&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Respuesta a la nutrici&#243;n enteral exclusiva</span><p id="par0065" class="elsevierStylePara elsevierViewall">Seis pacientes no completaron las 6-8 semanas de NEE&#59; 2 decidieron abandonarla tras 2 semanas y otros 4 recibieron esteroides tras 3 semanas de NEE al no constatarse respuesta&#46; La NEE se administr&#243; por v&#237;a oral&#44; salvo en un paciente&#44; que requiri&#243; sonda nasog&#225;strica&#46; La duraci&#243;n de la NEE fue de 6&#44;4 semanas &#40;RIC 6-8&#44;1&#41;&#46; De los 34 pacientes que completaron el per&#237;odo de NEE&#44; 32 &#40;94&#37; en el an&#225;lisis por protocolo&#41; alcanzaron la remisi&#243;n cl&#237;nica&#46; Este porcentaje descendi&#243; al 80&#37; en el an&#225;lisis por intenci&#243;n de tratar&#46; La tasa de cumplimiento fue del 95&#37;&#46; Se observ&#243; un aumento significativo en el peso&#44; niveles de alb&#250;mina&#44; hemoglobina y hematocrito junto con un descenso significativo de la CF&#44; PCR&#44; VSG&#44; leucocitos y plaquetas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; al final de la NEE&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Todos los pacientes toleraron bien la NEE y no hubo ninguno que declarara haber experimentado efecto secundario alguno durante este per&#237;odo&#46; Al finalizar la NEE&#44; se introdujeron progresivamente los diferentes grupos de alimentos sin incidencias&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">No se apreciaron diferencias significativas en la tasa de respuesta en relaci&#243;n a la gravedad del brote seg&#250;n el PCDAI<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> &#40;91&#37; vs&#46; 76&#37;&#44; p &#61; 0&#44;136&#41;&#44; aunque s&#237; se encontraron diferencias en la respuesta al aplicar los nuevos puntos de corte del PCDAI<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> &#40;90&#37; en EC leve&#44; 100&#37; en EC moderada y 68&#44;2&#37; en EC grave&#59; p &#61; 0&#44;05&#41;&#46; Tambi&#233;n se hallaron diferencias estad&#237;sticamente significativas en relaci&#243;n con la localizaci&#243;n de la EC &#40;88&#37; para L1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L3 vs&#46; 50&#37; para L2&#59; p &#61; 0&#44;047&#41;&#44; si bien solo 5 pacientes tuvieron una localizaci&#243;n L2 de la EC&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Seguimiento</span><p id="par0080" class="elsevierStylePara elsevierViewall">Diecinueve de los 32 pacientes &#40;59&#44;4&#37;&#41; que alcanzaron la remisi&#243;n cl&#237;nica hab&#237;an comenzado tratamiento precoz &#40;&#8804; 8 semanas despu&#233;s de iniciar la NEE&#41; con azatioprina &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Al final del periodo de seguimiento &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; 5 pacientes &#40;26&#44;3&#37;&#41; tratados con azatioprina como terapia de mantenimiento y 2&#40;15&#44;3&#37;&#41; que no hab&#237;an recibido tratamiento de mantenimiento continuaban en remisi&#243;n &#40;diferencia del 11&#37;&#59; intervalo de confianza &#91;IC&#93; del 95&#37;&#44;&#8722;3&#44;13&#37; a 25&#44;13&#37;&#59; p &#61; 0&#44;389&#41;&#46; No se detectaron diferencias entre grupos en el tiempo transcurrido hasta la reca&#237;da &#40;8&#44;1 meses &#91;RIC 3&#46;18&#93; en el grupo de azatioprina precoz vs&#46; 10 meses &#91;2&#44;6-24&#44;6&#93; en el grupo de azatioprina tard&#237;a&#59; p &#61; 0&#44;954&#41;&#46; La duraci&#243;n mediana del per&#237;odo de seguimiento fue de 2&#44;9 a&#241;os &#40;RIC 1&#44;8-4&#44;8&#41; para ambos grupos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nuestro estudio muestra que la NEE induce la remisi&#243;n cl&#237;nica y bioqu&#237;mica&#44; y la recuperaci&#243;n de peso en pacientes con nuevo diagn&#243;stico de EC&#46; Aunque no se realiz&#243; una endoscopia al finalizar la NEE&#44; la marcada reducci&#243;n en la CF indica una clara mejor&#237;a en el grado de inflamaci&#243;n de la mucosa intestinal<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12-15</span></a>&#46; La tasa de curaci&#243;n mucosa alcanzada con la NEE es similar&#44; en muchos casos&#44; a la obtenida por los anti-TNF&#44; y mayor que con los esteroides<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9-11&#44;24-26</span></a>&#46; Las publicaciones que argumentan estos resultados pueden estar sesgadas ya que es mucho m&#225;s probable que la NEE se administre en pacientes al debut o con enfermedad leve-moderada a diferencia de lo que ocurre con los esteroides o anti-TNF&#44; reservados para casos graves o con mayor tiempo de evoluci&#243;n&#46; No obstante&#44; al contrario que los esteroides&#44; la NEE tiene un efecto positivo sobre el crecimiento lineal&#44; con un incremento en la velocidad de crecimiento y en la densidad mineral &#243;sea en los 6 meses posteriores al inicio de la NEE<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27-30</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En un estudio reciente de 34 pacientes<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; el 58&#37; de los pacientes tratados con NEE alcanzaron la remisi&#243;n endosc&#243;pica &#40;evaluada mediante el &#237;ndice SES-CD<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#41; y el 21&#37; alcanz&#243; la remisi&#243;n transmural&#44; evaluada por medio de entero-resonancia magn&#233;tica&#46; Los autores demostraron que la remisi&#243;n endosc&#243;pica precoz se asociaba a tasas menores de reca&#237;da endosc&#243;pica&#44; a un uso menor de la terapia anti-TNF-&#945; y a un n&#250;mero menor de ingresos un a&#241;o despu&#233;s del diagn&#243;stico&#46; La respuesta fue m&#225;s favorable en pacientes con diagn&#243;sticos m&#225;s recientes&#46; El mismo estudio muestra que la inducci&#243;n de la remisi&#243;n con esteroides en lugar de con la NEE aumenta el riesgo de falta o p&#233;rdida de respuesta a la terapia anti-TNF-&#945;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La eficacia de la NEE se observ&#243; por primera vez al comienzo de los a&#241;os 70&#44; cuando se descubri&#243; que el estado cl&#237;nico y nutricional de algunos pacientes hab&#237;a mejorado con el tratamiento con una f&#243;rmula elemental mientras esperaban a ser operados&#46; Aunque se desconocen los mecanismos de acci&#243;n de la NEE&#44; existen varias hip&#243;tesis al respecto&#44; como la modificaci&#243;n de 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 debido a una reducci&#243;n de la cantidad de grasa en la dieta o el aporte de micronutrientes al intestino inflamado<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Un an&#225;lisis de los datos de m&#225;s de 25 estudios pedi&#225;tricos muestra que la eficacia global de la NEE es del 84&#37; &#40;IC del 95&#37;&#44; 81&#37;-87&#37;&#41;&#44; si bien los estudios difer&#237;an en las f&#243;rmulas enterales utilizadas&#44; los criterios de remisi&#243;n cl&#237;nica y la duraci&#243;n del tratamiento&#46; La tasa de cumplimiento es muy alta&#44; alcanzando el 90&#37; &#40;IC del 95&#37;&#44; 88&#37;-92&#37;&#41;&#46; No se han encontrado diferencias en las tasas de remisi&#243;n o de cumplimiento en relaci&#243;n con la f&#243;rmula enteral utilizada &#40;polim&#233;rica&#44; semielemental o elemental&#41; ni con suplementos de glutamina o de triglic&#233;ridos de cadena media<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; En nuestra serie solo se emple&#243; un tipo de f&#243;rmula espec&#237;fica para la EC enriquecida con TGF-&#946;&#44; no permiti&#233;ndose la ingesta de ning&#250;n otro alimento&#44; salvo agua durante el per&#237;odo de NEE&#46; La nutrici&#243;n enteral parcial &#40;con el 50&#37; de las calor&#237;as provenientes de una dieta normal&#41; ha demostrado ser menos efectiva que la NEE<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46; Otras modalidades&#44; como permitir que un 20&#37; de las calor&#237;as diarias estimadas proviniesen de otros alimentos&#44; no han mostrado una eficacia menor<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En un primer momento se pens&#243; que la terapia nutricional era m&#225;s efectiva en pacientes con afectaci&#243;n ileal que en aquellos con afectaci&#243;n exclusivamente col&#243;nica&#46; Actualmente&#44; no se dispone de datos para establecer una correlaci&#243;n entre la respuesta a la NEE y el fenotipo de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a>&#46; Hemos de a&#241;adir que en nuestra serie se apreciaron diferencias significativas en relaci&#243;n con la localizaci&#243;n&#44; aunque el n&#250;mero de pacientes con afectaci&#243;n exclusivamente col&#243;nica fue muy reducido&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Si bien nuestro estudio no fue dise&#241;ado para analizar el impacto del tratamiento precoz con tiopurinas en la evoluci&#243;n de la enfermedad tras la inducci&#243;n de la remisi&#243;n&#44; se observ&#243; que&#44; aunque no hubo diferencias en el mantenimiento de la remisi&#243;n entre pacientes con tratamiento precoz &#40;&#8804; 8 semanas&#41; y con tratamiento tard&#237;o &#40;&#62; 8 semanas&#41; &#40;v&#233;ase la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; los pacientes tratados precozmente requirieron menos esteroides durante el seguimiento &#40;p &#61; 0&#44;001&#41;&#46; Nuestros resultados concuerdan con los de otros estudios realizados tanto en ni&#241;os<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;37</span></a> como adultos<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">38&#44;39</span></a> y difieren de los resultados publicados por Markovitz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">40</span></a> Es posible que esta discrepancia entre estudios pedi&#225;tricos se deba&#44; en parte&#44; a que ninguno de los pacientes en el estudio de Markovitz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">40</span></a> fue tratado con NEE para inducir la remisi&#243;n&#44; ya que es sabido que es poco probable conseguir la curaci&#243;n de la mucosa mediante el tratamiento con esteroides&#46; Se requieren m&#225;s estudios para establecer recomendaciones sobre el momento &#243;ptimo del inicio del tratamiento con inmunomoduladores en la EC pedi&#225;trica&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Este estudio ofrece informaci&#243;n valiosa sobre la eficacia de la NEE en la EC pedi&#225;trica&#46; La limitaci&#243;n m&#225;s importante es el n&#250;mero reducido de pacientes&#44; que probablemente lleva a subestimar el efecto de las tiopurinas en el an&#225;lisis retrospectivo de los datos&#44; y que dificulta la obtenci&#243;n de informaci&#243;n m&#225;s consistente&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la administraci&#243;n de NEE durante 6-8 semanas es efectiva en la inducci&#243;n de la remisi&#243;n cl&#237;nica y bioqu&#237;mica&#44; mejorar los par&#225;metros antropom&#233;tricos y reducir el grado de inflamaci&#243;n de la mucosa intestinal&#46; La CF permite monitorizar la respuesta a la NEE y el control del grado de inflamaci&#243;n de la mucosa&#46; Los pacientes tratados precozmente con tiopurinas recibieron menos esteroides durante el seguimiento&#46; El per&#237;odo de NEE es clave para la actualizaci&#243;n del calendario vacunal y para la solicitud de las pruebas complementarias necesarias antes de comenzar el tratamiento inmunosupresor&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicto de intereses</span><p id="par0125" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de inter&#233;s&#46;</p></span></span>"
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              "titulo" => "Combinaci&#243;n de nutrici&#243;n enteral exclusiva con tratamiento farmacol&#243;gico"
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              "titulo" => "Respuesta a la nutrici&#243;n enteral exclusiva"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La nutrici&#243;n enteral exclusiva &#40;NEE&#41; ha demostrado ser m&#225;s efectiva que los esteroides para alcanzar la curaci&#243;n mucosa sin sus efectos secundarios&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar la eficacia de la NEE para inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n mucosa en pacientes con EC durante su primer brote&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n de las historias cl&#237;nicas de pacientes con EC tratados con NEE durante su primer brote&#46; El grado de inflamaci&#243;n mucosa se estim&#243; mediante la calprotectina fecal &#40;CF&#41;&#46; Se defini&#243; remisi&#243;n como PCDAI &#60; 10&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 40 pacientes &#40;24 varones&#41; con una edad al diagn&#243;stico de 11&#44;6 &#177; 3&#44;6 a&#241;os&#46; La duraci&#243;n de la NEE fue de 6&#44;42 semanas &#40;RIC 6&#44;0-8&#44;14&#41;&#46; De los 34 pacientes que completaron el per&#237;odo de NEE&#44; 32 &#40;94&#37; en el an&#225;lisis por protocolo&#41; alcanzaron la remisi&#243;n cl&#237;nica&#46; Este porcentaje descendi&#243; al 80&#37; en el an&#225;lisis por intenci&#243;n de tratar&#46; La tasa de cumplimiento fue del 95&#37;&#46; Los valores de CF fueron significativamente m&#225;s altos en pacientes con brotes moderados y graves&#46; La CF basal fue de 680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g y descendi&#243; de forma significativa a 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g al final del periodo de NEE &#40;p &#60; 0&#44;0001&#41;&#46; Hubo correlaci&#243;n estad&#237;sticamente significativa entre CF y PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;727&#59; p &#60; 0&#44;0001&#41;&#46; La introducci&#243;n precoz del tratamiento con tiopurinas &#40;antes de las 8 semanas&#41; no se asoci&#243; a una mejor evoluci&#243;n durante el seguimiento&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La NEE administrada durante 6-8 semanas es efectiva para inducir la remisi&#243;n cl&#237;nica y mejorar el grado de inflamaci&#243;n mucosa&#46; No encontramos diferencias en t&#233;rminos de mantenimiento de la remisi&#243;n en pacientes tratados precozmente con tiopurinas&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Exclusive enteral nutrition &#40;EEN&#41; has been to be more effective than corticosteroids in achieving mucosal healing without their side effects&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the efficacy of EEN in terms of inducing clinical remission in newly diagnosed CD children and to study the efficacy of this therapeutic approach in improving the degree of intestinal mucosa inflammation&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materials and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The medical records of patients with newly diagnosed Crohn&#39;s disease treated with EEN were reviewed retrospectively&#46; The degree of mucosal inflammation was assessed by fecal calprotectin &#40;FC&#41;&#46; Remission was defined as a PCDAI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>10&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Forty patients &#40;24 males&#41; were included&#44; the age at diagnosis was 11&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;6 years&#46; Of the 34 patients who completed the EEN period&#44; 32 &#40;94&#37; per-protocol analysis&#41; achieved clinical remission&#46; This percentage fell to 80&#37; in the intention-to-treat analysis&#46; The compliance rate was 95&#37;&#46; Duration of EEN was 6&#46;42 weeks &#40;IQR 6&#46;0&#8211;8&#46;14&#41;&#46; FC was significantly higher in patients with moderate and severe disease&#46; Median baseline FC levels &#40;680<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g&#41; decreased significantly to 218<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;g <span class="elsevierStyleItalic">&#40;P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; after EEN&#46; We found a statistically significant correlation between FC and PCDAI &#40;rho<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;727&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; Early use of thiopurines &#40;&#60; 8 weeks&#41; versus subsequent use was not associated with improved outcomes during the follow-up&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">EEN administered for 6-8 weeks is effective for inducing clinical remission and decreasing the degree of mucosal inflammation&#46; We did not find differences in terms of maintenance of remission in patients treated early with thiopurines&#46;</p></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Antecedente familiar de EII</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;2 &#40;RIC 2&#44;3-12&#44;1&#41;&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="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Clasificaci&#243;n de Par&#237;s</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;12&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>L3<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>L4 &#40;extensa&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>B2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCDAI</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Tratamiento al inicio de la NEE</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>5-ASA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&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="table-entry  " align="left" valign="top">PCR &#40;mg&#47;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#44;9 &#40;RIC 16&#44;5-67&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;1 &#40;RIC 2&#44;4-9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">VSG &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;RIC 21&#44;5-49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;RIC 7-16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alb&#250;mina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;2 &#40;RIC 2&#44;7-3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;1 &#40;RIC 3&#44;7-4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hemoglobina &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;4 &#40;RIC 9&#44;9-12&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;8 &#40;RIC 11&#44;5-13&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hematocrito &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;2 &#40;RIC 31&#44;7-37&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;RIC 35-39&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Leucocitos &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;6 &#177; 3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;7 &#177; 2&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Plaquetas &#40;&#215;10<span class="elsevierStyleSup">3</span>&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">533 &#177; 140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">443 &#177; 150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento precoz con IM &#40;&#8804; 8 semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tratamiento posterior con IM &#40;&#62; 8 semanas&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Valor <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">N&#250;mero de pacientes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad al diagn&#243;stico &#40;a&#241;os&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;9 &#177; 2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;9 &#177; 3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo de evoluci&#243;n al diagn&#243;stico &#40;meses&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#44;4 &#40;RIC 3&#44;7-12&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;5 &#40;RIC 1&#44;4-4&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L1</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;19 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;530&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;19 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;13 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#47;19 &#40;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#47;13 &#40;77&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;052&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">L4a o L4b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;19 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;066&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Retraso del crecimiento</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;19 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;13 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Afectaci&#243;n perianal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;19 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;13 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">IMC&#44; mediana &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;7 &#40;RIC 15&#44;4-18&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;RIC 14-19&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCDAI&#44; mediana</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;RIC 27&#44;5-42&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;RIC 30-46&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;545&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">CF&#44; media &#40;&#956;g&#47;g&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">680 &#177; 154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">596 &#177; 210&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;326&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">PCR&#44; mediana &#40;mg&#47;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;RIC 16-47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 &#40;RIC 23-85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">VSG&#44; mediana &#40;mm&#47;h&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;RIC 20&#44;7-39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">51 &#40;RIC 22-62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Alb&#250;mina&#44; mediana &#40;g&#47;dl&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;3 &#40;RIC 2&#44;9-3&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;RIC 2&#44;4-3&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;588&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Plaquetas&#44; media &#40;&#215;103&#47;&#956;l&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">506 &#177; 107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">547 &#177; 149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;735&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Niveles altos de TPMT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;13 &#40;84&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;6 &#40;66&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Niveles intermedios de TPMT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;13 &#40;15&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;6 &#40;33&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;373&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Seguimiento</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tiempo hasta la reca&#237;da &#40;meses&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;1 &#40;RIC 3-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;RIC 2&#44;6-24&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;954&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tasa de reca&#237;da a los 12 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;19 &#40;47&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;13 &#40;53&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;719&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tasa de reca&#237;da a los 18 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;7 &#40;14&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tasa de reca&#237;da a los 24 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;6 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;4 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;429&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;83 &#40;RIC 1&#44;1-4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;57 &#40;RIC 1&#44;8-5&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;343&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#47;19 &#40;94&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;406&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#44;8 &#40;RIC 3-23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;RIC 8-57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#44;583&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de los pacientes con tratamiento precoz &#40;&#8804; 8 semanas&#41; o posterior &#40;&#62; 8 semanas&#41; con inmunomoduladores&#44; al diagn&#243;stico y durante el seguimiento</p>"
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Información del artículo
ISSN: 16954033
Idioma original: Español
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