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Mechanisms of growth impairment in pediatric Crohn's disease

Thomas D Walters1, Anne M Griffiths

  • 1Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8, Canada. anne.griffiths@sickkids.ca

Nature Reviews. Gastroenterology & Hepatology
|August 29, 2009
PubMed

Insights

Pediatric Crohn's disease can impair growth due to inflammation affecting insulin-like growth factor I (IGF-I). Novel therapies targeting inflammation show promise in improving growth outcomes for children with Crohn's disease.

Area of Science:

  • Pediatric Gastroenterology
  • Endocrinology
  • Inflammation Research

Background:

  • Crohn's disease affects up to 25% of patients during childhood or adolescence.
  • Linear growth impairment is a unique complication of chronic intestinal inflammation in pediatric populations.
  • Insulin-like growth factor I (IGF-I) mediates growth hormone (GH) effects, and low IGF-I is linked to impaired growth in pediatric Crohn's disease.

Purpose of the Study:

  • To explore the mechanisms underlying growth impairment in pediatric Crohn's disease.
  • To investigate the roles of malnutrition, proinflammatory cytokines, and other factors in growth suppression.
  • To assess the potential of novel therapies for improving growth outcomes.

Main Methods:

  • Review of existing literature on growth impairment in pediatric Crohn's disease.
  • Analysis of the impact of malnutrition on IGF-I production.
  • Exploration of the growth-inhibitory effects of proinflammatory cytokines and lipopolysaccharides on the growth axis.

Main Results:

  • While malnutrition contributes, it doesn't fully explain growth impairment in pediatric Crohn's disease.
  • Proinflammatory cytokines and potentially noncytokine factors like lipopolysaccharides negatively influence the growth axis.
  • Anticytokine therapies offer optimism for reducing growth complications.

Conclusions:

  • Growth impairment in pediatric Crohn's disease is multifactorial, involving inflammation beyond simple malnutrition.
  • Understanding the growth axis's response to inflammatory mediators is crucial.
  • Advancements in understanding these mechanisms pave the way for targeted therapies to improve growth in affected children.

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