Clinical features affecting final adult height in patients with pediatric-onset Crohn's disease
Andrew Sawczenko1, Anne B Ballinger, Martin O Savage
1Research Centre in Gastroenterology, Institute of Cell and Molecular Science, Barts and The London, Turner Street, London E1 2AD, United Kingdom.
Insights
Pediatric Crohn's disease can impact adult height, with diagnosis timing and jejunal disease affecting final stature. Earlier diagnosis and treatment may improve growth outcomes for children with Crohn's disease.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Genetics
Background:
- Growth failure is a known complication of pediatric-onset Crohn's disease.
- Limited data exist on the final adult height achieved by these patients.
Purpose of the Study:
- To determine the final adult height in patients with pediatric-onset Crohn's disease.
- To identify clinical features influencing long-term growth impairment.
Main Methods:
- Retrospective study of 123 patients diagnosed before age 16.
- Analysis of factors including diagnosis interval, disease location (jejunal), and treatment (steroids, surgery).
- Height SD scores compared to midparental height, with univariate and regression analyses.
Main Results:
- Mean final height deficit was -2.4 cm compared to target height.
- Nineteen percent of patients were more than 8.0 cm below target height.
- Earlier diagnosis and jejunal disease presence negatively impacted final height SD scores.
Conclusions:
- While mean final height shows a modest deficit, a significant proportion of patients experience substantial growth impairment.
- Earlier diagnosis and optimized treatment of jejunal disease are crucial for improving final adult height in pediatric Crohn's disease.
Background:
Growth failure is a recognized complication of pediatric-onset Crohn's disease, but there are few data on final adult height.
Objective:
Our purpose with this work was to determine adult height and the clinical features that influence long-term growth impairment.
Methods:
We retrospectively studied 123 patients with Crohn's disease (65 male and 58 female) who had reached adult height. All of the case subjects were diagnosed before age 16.0 years. Heights were converted to SD scores and univariate analysis performed of factors postulated to influence final height, that is, interval from onset of symptoms to diagnosis, prepubertal onset of symptoms, gender, jejunal disease present at diagnosis, systemic steroid therapy, intestinal surgery, and midparental height SD scores. Significant univariate factors were additional analyzed in regression models.
Results:
Mean height deficit at diagnosis was -0.50 SD scores, which improved to -0.29 SD scores at final height. Mean final height compared with target height, calculated from parental height, was -2.4 cm (range: -20.0 to 9.0 cm). Nineteen percent of the case subjects achieved a final height >8.0 cm below target height. The length of the interval between symptom onset and diagnosis correlated negatively with height SD scores at diagnosis. Height SD scores at diagnosis were related to final height SD scores, independent of midparental height. The presence of jejunal disease was negatively related to final height.
Conclusions:
Mean final adult height showed a modest deficit compared with target height, but in one fifth of patients, final height was significantly less than target height. Earlier diagnosis and improved treatment of jejunal disease would be likely to improve final height.
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