Mucosal healing and a fall in mucosal pro-in¯ammatory cytokine mRNA induced by a speci®c oral polymeric diet in paediatric Crohn's disease J. M. E. FELL*, M. PAINTIN  , F. ARNAUD-BATTANDIER à , R. M. BEATTIE§, A. HOLLIS ± , P. KITCHING**, A. DONNET-HUGHES  , T. T. MACDONALD ± & J. A. WALKER-SMITH** *Chelsea and Westminster Hospital, London, UK;  Nestec, Centre de Recherche Nestle, Vers chez les Blanc, Switzerland; àNestle Clinical Nutrition, Sevres, France; §Peterborough District Hospital, Peterborough, UK; ±St Bartholomew's Hospital, London, UK; and **Royal Free Hospital, London, UK Accepted for publication 28 October 1999 INTRODUCTION The relative merits of corticosteroids and enteral nutrition in the treatment of Crohn's disease remains an area of controversy. Although meta-analysis of the clinical trials comparing enteral nutrition therapy with corticosteroids suggests that enteral nutrition may not be as effective in inducing clinical remission, enteral therapy has the signi®cant advantage over corticoster- oids in having fewer side-effects. 1±3 In children in particular, the relative sparing of linear growth achieved with nutritional therapy, con®rmed in several trials is a major consideration in deciding which treatment to use. 4±6 A signi®cant problem with enteral nutritional therapy, however, is compliance; feeds in the past have been 1 SUMMARY Background: Although enteral nutrition is a recognized form of treatment for intestinal Crohn's disease, there are persisting problems with feed palatability and only limited data as to its mode of action. Aim: To assess the effects of a speci®c oral polymeric diet (CT3211; Nestle, Vevey, Switzerland), which is rich in transforming growth factor b 2 , on the mucosal in¯ammatory process. Methods: Twenty-nine consecutive children with active intestinal Crohn's disease were treated with CT3211 as the sole source of nutrition for 8 weeks. Patients were assessed clinically, and endoscopically, whilst cytokine mRNA was measured in mucosal biopsies before and after treatment by quantitative reverse transcriptase polymerase chain reaction. Results: After 8 weeks 79% of children were in complete clinical remission. Macroscopic and histologi- cal healing in the terminal ileum and colon was associated with a decline in ileal and colonic interleu- kin-1b mRNA (pre-treatment to post-treatment ratio 0.008 and 0.06: P < 0.001, P  0.006). In the ileum there was also a fall in interferon c mRNA (ratio 0.15, P < 0.001) with a rise in transforming growth factor b1 mRNA (ratio 10, P  0.04), whilst in the colon interleukin-8 mRNA fell with treatment (ratio 0.06, P < 0.05). Conclusions: The clinical response to oral polymeric diet CT3211 is associated with mucosal healing and a down regulation of mucosal pro-in¯ammatory cytokine mRNA in both the terminal ileum and colon. In the ileum there was also an increase in transforming growth factor b1 mRNA. Correspondence to: Dr J. M. E. Fell, Academic Department of Child Health, Imperial College School of Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK. E-mail: j.fell@ic.ac.uk Aliment Pharmacol Ther 2000; 14: 281±289. Ó 2000 Blackwell Science Ltd 281