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Growth in children receiving contemporary disease specific therapy for Crohn's disease
Salma Malik1, Avril Mason, Andisheh Bakhshi
1Department of Child Health, University of Glasgow, Bone and Endocrine Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Insights
Despite advances in Crohn's disease (CD) therapy, many children still experience short stature and slow growth. Consistent definitions are needed to identify poor growth in pediatric chronic diseases.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Chronic Disease Management
Background:
- Growth retardation is a known complication in pediatric Crohn's disease (CD).
- Recent therapeutic advances for CD may impact childhood growth.
- Current UK CD therapy trends show reduced long-term glucocorticoid use.
Purpose of the Study:
- To determine the frequency of short stature and poor growth in children with CD.
- To investigate the relationship between growth, disease course, and therapies in pediatric CD.
- To assess the impact of modern CD treatments on growth outcomes.
Main Methods:
- Retrospective analysis of anthropometric and treatment data from 116 children with CD.
- Data collected at diagnosis, 1, 2, 3 years post-diagnosis, and at maximum follow-up.
- Evaluation of height standard deviation score (HtSDS) and height velocity (HV) SDS.
Main Results:
- Children with CD exhibited a lower mean height standard deviation score (HtSDS) at diagnosis compared to mid-parental HtSDS.
- Mean HtSDS remained below average throughout the follow-up period.
- Height standard deviation score (HtSDS) was negatively associated with prednisolone, azathioprine, and methotrexate use.
Conclusions:
- Short stature and slow growth persist in a significant proportion of children with CD, despite therapeutic improvements.
- Current CD therapies show some benefits in early growth rates but do not fully resolve growth issues.
- Standardized growth assessment definitions are crucial for children with chronic diseases like CD.
Introduction:
It is unclear whether recent therapeutic advances have improved the growth of children with Crohn's disease (CD).
Aim:
To assess the frequency of short stature and poor growth and their relationship to disease course and therapy in children with CD. WHAT IS ALREADY KNOWN ON THIS TOPIC: Growth retardation may occur in children with Crohn's disease (CD). Current therapy for CD in the UK is less likely than previously to involve the use of long-term glucocorticoids.
What This Study Adds:
Despite advances in therapy, short stature and slow growth continue to be encountered in children with CD. There is a need for simple and consistent definitions of growth that can identify poor growth in children with chronic disease.
Methods:
The anthropometric and treatment details of 116 children (68 male) with a mean (range) age at diagnosis of 10.8 years (4.9-15.5) and a mean age at maximum follow-up (MF) of 15.4 years (9.4-19.3) were studied retrospectively at diagnosis (T0), at 1 (T1), 2 (T2) and 3 years (T3) after diagnosis and at MF.
Results:
At T0, mean height SD score (HtSDS) was -0.5 (-3.3 to 2.6) compared to a mid-parental HtSDS of 0.2 (-2.0 to 01.4) (p=0.002). At T1, T2, T3 and MF, mean HtSDS was -0.6 (-4.8 to 7.8), -0.6 (-2.9 to 2.2), -0.7 (-3.6 to 2.5) and -0.5 (-3.5 to 2.9), respectively. Mean Ht velocity (HV) SDS at T1, T2, T3 and MF was -1.4 (-7.4 to 7.4), -0.6 (-7.5 to 6.1), -0.1 (-6.6 to 7.6) and 0.6 (-4.8 to 7.8), respectively (p<0.05). In final models, HtSDS was associated negatively with the use of prednisolone (p=0.0001), azathioprine (p=0.0001), methotrexate (p=0.0001) and weight SDS (WtSDS) (p=0.0001). HVSDS was associated positively with age (p=0.0001) and WtSDS (p=0.01). ΔHtSDS was associated negatively with use of prednisolone (p<0.02).
Conclusion:
Although current therapy for CD is associated with improved rate of growth for the first few years, a substantial proportion of children remain short. This study also highlights the need for consistency in describing growth in children with chronic diseases.
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