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Exclusive enteral nutrition(EEN) is the cornerstone for the induction of remission in the mild to moderate form of active paediatric Crohn’s disease(CD). 1 2 While this steroid-sparing treatment, endorsed by the ECCO-ESPGHAN 2021 guidelines, is effective in inducing short-term remission in CD patients,3 exploration of sustained effects in the multi-ethnic UK paediatric cohort remains limited in the literature.Objective This study evaluated the remission rates post-EEN at 6 weeks and 6 months in children newly diagnosed with CD at a tertiary care centre. The study focused on exploring anthropometric, demographic, biochemical and phenotypic predictors of remission in the cohort.Methods The single-centre retrospective study included 58 out of 74 eligible children aged <17 years with a new diagnosis of CD, who completed a 6-week course of EEN from January 2023 to January 2025. Data were extracted from an electronic medical record system called Cerner Millennium (CRS) from a tertiary care centre in London, UK. Remission rates were calculated 6 weeks and 6 months post-EEN completion through biochemical markers (ESR, CRP and albumin), from physician assessment through clinic letters and Paediatric Crohn’s Disease Activity Index (PCDAI) scores. Statistical analysis using SPSS was performed. Odds ratios and p-values were calculated to assess significance, which was set at p < 0.05.Results Following the completion of EEN at 6 weeks, 38/58 (66.0%) of patients achieved both biochemical and clinical remission. Sustained remission rate at 6 months was 36/58 (62.1%), of whom 80.6% required escalation therapy with biologics or immunomodulators, or a combination of both. CRP and ESR emerged as the strong predictors of remission (p < 0.001 and p = 0.006 at 6 weeks, respectively) and (p < 0.001 for both) at 6 months. The odds ratios at 6 months were 17.6 and 13.6, respectively. Serum albumin and BMI improved during EEN therapy (p < 0.001); however, they did not retain their predictive value at 6 months post-EEN (p = 1.000). Terminal ileal disease (L1) showed the highest remission rate with EEN alone, 88.9% at 6 weeks. At 6 months, Ileocolonic disease (L3) showed the highest remission rate, 70.4% with EEN and combination therapy. However, they did not reach statistical significance (p>0.05) when compared to other phenotypes. Child’s age and gender also did not influence remission rates across both time points.Conclusion EEN is effective in inducing remission in active paediatric CD, especially in the short term. However, maintenance often requires escalation to combination therapy with immunomodulators or biologics, reflecting the high-risk cohort in this centre. The CRP and ESR are significant predictors of response to EEN, and their predictive strength is independent of phenotype and escalation, suggesting their normalisation as a biochemical threshold for the durability of the treatment. The nutritional benefits from EEN are undeniable, but they are not predictive of remission, thus reinforcing the need for CRP and ESR-driven monitoring approaches in clinical practice. The study aligns with the growing consensus that disease phenotype should not limit EEN use, supporting its universal application as induction therapy in paediatric Crohn’s disease.References Ashton JJ, Gavin J, Beattie RM. Exclusive enteral nutrition in Crohn’s disease: evidence and practicalities. Clin Nutr 2019 Feb;38(1):80–89. doi: 10.1016/j.clnu.2018.01.020. Epub 2018 Feb 15. PMID: 29398336.Sandrine C, Emmanuelle D, Jérôme V, Martinez-Vinson C. Exclusive enteral nutrition for induction of remission in pediatric Crohn’s disease: short- and long-term tolerance and acceptance. JPGN Rep 2024 Dec 30;6(1):11–18. doi: 10.1002/jpr3.12163. PMID: 39944105; PMCID: PMC11810808.van Rheenen PF, Aloi M, Assa A, Bronsky J, Escher JC, Fagerberg UL, et al. The medical management of paediatric crohn’s disease: an ECCO-ESPGHAN guideline update. J Crohns Colitis 2021;15(2):171–194.