Objective:

To compare the efficacy and safety of enteral nutrition therapies versus immunomodulators and corticosteroids for remission induction and maintenance in pediatric Crohn's disease.

Key Findings:

• EEN was significantly superior to corticosteroids for clinical remission induction (OR 1.72; 95% CI 1.18–2.52).
• EEN showed marked superiority for mucosal healing compared to corticosteroids (OR 7.55; 95% CI 3.59-15.88).
• SUCRA rankings for remission induction: CDED + PEN (0.80), EEN (0.78), MTX (0.55), AZA/6-MP (0.47), CS (0.31), PEN (0.08).
• For maintenance, AZA/6-MP was superior to placebo (OR 12.50; 95% CI 2.47–63.14).
• Enteral nutrition therapies had serious adverse event rates of 0%–3.1%, compared to 15.1% for CS and 11.8% for AZA/6-MP.

Interpretation:

EEN and CDED + PEN are the most effective treatments for inducing clinical and endoscopic remission in pediatric Crohn's disease, with better safety profiles than pharmacological therapies.

Limitations:

• Limited number of studies included in the analysis.
• Variability in study designs and populations may affect generalizability.

Conclusion:

EEN and CDED + PEN should be considered first-line induction therapies in pediatric Crohn's disease, while immunomodulators are essential for maintenance therapy.