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Letter: reproducible evidence shows that exclusive enteral nutrition significantly reduces faecal calprotectin concentrations in children with active Crohn's disease—Authors' reply

EDITORS, We thank Drs. Logan and colleagues for taking an interest in our paper and raising an important point regarding data on faecal calprotectin. Only 1 study in our systematic review contained information regarding faecal calprotectin. Levine et al measured faecal calprotectin at baseline and at end of treatment in patients induced with exclusive enteral nutrition and corticosteroids. Among those induced with exclusive enteral nutrition, 22 of 72 had normalisation of faecal calprotectin. Only 3 of 23 treated with corticosteroids had normalisation of faecal calprotectin. Although the difference was not statistically significant, the trend was towards greater improvement in the exclusive enteral nutrition group (OR 2.93, [CI 95% 0.7910.90]). Because only 1 study met our inclusion criteria, we did not feel it met the threshold to be included in the final manuscript, but failed to update the abstract. We agree that the absence of statistical benefit does not imply an absence of benefit, but simply that the literature we reviewed was not mature enough to have enough studies with which to base any conclusions. Logan et al do provide data on improvement in faecal from studies which did not meet our inclusion criteria. We agree that biomarkers have taken on a large importance in the management of Crohn’s disease, and that future rigorous comparison studies of Crohn’s nutritional therapy should include biomarker and mucosal healing data as part of their design.