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Growth in paediatric Crohn's disease
J P Cezard1, G Touati, C Alberti
1The French Group of Paediatric Gastroenterology and Nutrition, Hôpital Robert Debré, Paris, France. jean-pierre.cezard@rdb-ap-hop-paris.fr
Insights
Growth failure in pediatric Crohn's disease (CD) affects over 20% of patients, impacting bone and sexual development. New therapeutic strategies are needed to address this persistent complication in children with CD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Pediatric Endocrinology
Background:
- Growth failure (GF) is a significant complication in pediatric inflammatory bowel disease (IBD), particularly Crohn's disease (CD), affecting linear growth, bone development, and sexual maturation.
- While temporary GF occurs in 40-50% of pediatric CD cases, prolonged GF impacts 10-20%, and is rare in ulcerative colitis (5%).
- Causes of GF include poor nutritional intake, increased energy expenditure due to inflammation, intestinal losses, hypopituitarism, and corticosteroid treatment.
Purpose of the Study:
- To evaluate the prevalence and persistence of growth failure in children with Crohn's disease over a 2-year follow-up period.
- To identify factors associated with growth failure in pediatric CD patients.
- To inform the development of future therapeutic strategies for managing growth failure in pediatric CD.
Main Methods:
- A prospective, multicenter study followed 82 children with Crohn's disease for 2 years.
- Growth parameters (specifically, Z-scores for height) were monitored throughout the study period.
- Data on steroid use, enteral nutrition, and disease severity were collected and analyzed in relation to growth outcomes.
Main Results:
- Initially, 15% of patients had severe growth failure (<-2 SD), with 11 of these remaining below -2 SD after 2 years.
- An additional 6% of patients developed growth failure during the follow-up, resulting in 21% of the cohort exhibiting growth failure at 2 years.
- No significant differences in initial growth velocity, steroid use, enteral nutrition, or disease severity were observed between patients with and without growth failure.
Conclusions:
- A significant proportion of children with Crohn's disease experience persistent growth failure, even with current therapeutic approaches.
- The study highlights the need for novel treatment strategies to effectively manage growth failure as a complication of pediatric CD.
- Further research is warranted to understand the underlying mechanisms and develop targeted interventions for improving growth outcomes in these patients.
Abstract:
Growth failure (GF) is one of the major complications affecting children with inflammatory bowel disease. The faltering is temporary in 40-50% of cases and prolonged in 10-20% in Crohn's disease (CD). Such failure is rare in children with ulcerative colitis (5%). This complication is often associated with retarded bone development and delayed onset of sexual maturation. The delayed linear growth has a variety of causes including insufficient intake due to anorexia and the inflammatory process with increased energy and protein expenditure. Other factors are increased intestinal loss, secondary hypopituitarism and treatment with steroids. Therapeutic strategies of CD in children have changed this last decade by introducing new therapeutic agents such as topic steroids, immunosuppressors, anti-TNF (antibody and notably in children enteral nutrition which has shown its efficacy in inducing remissions of active CD, restoring nutritional status and stimulation of linear growth. The results of a recent prospective multicentric study over 2 years in 82 CD show that severe GF (-2 SD) is initially present in 15% (n = 12), among them 11 remain < -2SD after 2 years of follow-up. Six patients who were on the normal range initially increased their GF during the follow-up (< -2SD) (total 21% < -2SD (n = 17) at 2 years). At inclusion in this group there was no difference in growth velocity, used of steroids, enteral nutrition or severity of CD as compared to the group with no GF. It suggests that new treatment strategy should be developed in the future for this specific complication of paediatric CD.