Pharmaconutrition in children with IBD and necrotizing enterocolitis: A review of the literature

Inflammatory bowel disease and necrotizing enterocolitis are sustained by immunoinflammatory responses that can be modulated by various dietary components. Taken together, these two entities allow to summarize the main clinical experience with pharmaconutrients in children. Review of the literature shows that the experimental basis for the expected clinical efficacy of these dietary components is quite strong. However, there is only minimal evidence of any clinical benefit of pharmaco-nutrients in inflammatory bowel disease and necrotizing enterocolitis. Among all pharmaconutrients, probiotics show the best evidence of clinical benefit mainly for the treatment and prevention of chronic pouchitis in patients undergoing colectomy for ulcerative colitis and for the prevention of moderate to severe forms of necrotizing enterocolitis in preterm infants. Among the remaining available pharmaco-nutrients, arginine and transforming growth factor-β appear to be promising in preventing necrotizing enterocolitis and modulating the inflammatory response in Crohn's disease, respectively. Large multi-center studies will be needed to confirm these data.