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Published on: March 1, 2022
Growth problems in children with IBD
1Centre for Digestive Diseases, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London. 4 Newark Street, London E1 2AT, UK.
Insights
Pediatric Crohn
Area of Science:
- Pediatric gastroenterology and endocrinology.
- Inflammatory bowel disease research.
Background:
- Crohn's disease (CD) in children frequently causes linear growth retardation, impacting disease management.
- Growth failure is less common in pediatric ulcerative colitis (UC).
- Approximately one-third of pediatric CD patients exhibit growth retardation at diagnosis.
Purpose of the Study:
- To investigate the mechanisms behind growth retardation in pediatric Crohn's disease.
- To explore potential therapeutic targets for growth failure in CD.
Main Methods:
- Analysis of growth patterns in pediatric CD patients.
- Review of the roles of inflammation, undernutrition, and immune dysfunction in growth.
- Examination of the impact of cytokines and growth hormone insensitivity.
Main Results:
- Growth retardation in pediatric CD is a disease consequence, not solely due to corticosteroid treatment.
- Both inflammation and undernutrition contribute to reduced height velocity.
- Cytokine production affects insulin-like growth factor 1 (IGF-1) and growth plate chondrocytes.
- Growth hormone insensitivity, linked to immune dysfunction, is a key mechanism.
Conclusions:
- Inflammation resolution is crucial for managing growth retardation in pediatric CD.
- Growth hormone and IGF-1 therapies may benefit patients with refractory inflammation.
- Understanding these mechanisms is vital for optimizing pediatric IBD care.
Abstract:
Crohn's disease in childhood causes linear growth retardation, which has a substantial effect on management of this disease. By contrast, growth is rarely a problem in children presenting with ulcerative colitis. Depending on how growth failure is defined, approximately one-third of children with Crohn's disease have growth retardation at diagnosis. Although corticosteroids can suppress growth, decreased height at diagnosis demonstrates that this finding is a consequence of the disease and not merely an adverse effect of treatment. Both inflammation and undernutrition contribute to decreased height velocity. Increased cytokine production acts both on the hepatic expression of insulin-like growth factor 1 (IGF-1) and at chondrocytes of the growth plates of long bones. Growth hormone insensitivity caused by deranged immune function is a major mechanism in growth retardation. Resolution of inflammation is the cornerstone of treatment, but current studies on growth hormone and IGF-1 might yield therapies for those children whose inflammation is refractory to treatment.
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