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Published on: September 20, 2018
Growth failure in pediatric onset inflammatory bowel disease: mechanisms, epidemiology, and management
1Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Insights
Pediatric inflammatory bowel disease (IBD) often causes growth failure. Treatments like anti-tumor necrosis factor (TNF) agents and avoiding corticosteroids (CS) can improve growth, emphasizing the importance of deep remission.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Growth and Development Studies
Background:
- Growth impairment is a major complication in pediatric inflammatory bowel disease (IBD), affecting 15-40% of Crohn's disease (CD) and 3-10% of ulcerative colitis (UC) patients at diagnosis.
- Growth failure in IBD is multifactorial, linked to reduced appetite, malabsorption, inflammation-induced growth hormone (GH) resistance, and genetic factors.
- Pre-pubertal onset of CD is associated with a higher risk of growth failure, impacting final adult height compared to healthy peers.
Purpose of the Study:
- To review the impact of IBD on pediatric growth.
- To identify factors contributing to growth failure in pediatric IBD patients.
- To summarize effective IBD treatments for improving growth in children.
Main Methods:
- Literature review of population-based and cohort studies on pediatric IBD and growth.
- Analysis of factors associated with growth failure, including disease onset and specific IBD types.
- Evaluation of the efficacy of various IBD treatments on pediatric growth outcomes.
Main Results:
- Growth failure is a significant concern at diagnosis for pediatric IBD, particularly in Crohn's disease.
- While final adult height may remain suboptimal, treatment interventions can improve growth trajectories.
- Enteral nutrition and anti-tumor necrosis factor (TNF) agents show promise in enhancing growth, especially in pre-pubertal CD.
- Minimizing corticosteroid (CS) use and achieving deep remission are crucial for optimizing growth in pediatric IBD.
Conclusions:
- Effective management of pediatric IBD, focusing on nutritional support, targeted therapies like anti-TNF agents, and minimizing CS exposure, is vital for improving growth outcomes.
- Achieving deep remission is a key strategy for ensuring optimal growth and development in children with IBD.
- Further research into growth dynamics and treatment efficacy in pediatric IBD is warranted.
Abstract:
Impairment of growth is recognized as one of the most significant complications of inflammatory bowel disease (IBD) in pediatric patients. The reported incidence of growth failure at diagnosis is 15-40% in pediatric onset Crohn's disease (CD) and 3-10% in ulcerative colitis (UC). Growth failure is associated with decreased appetite, abdominal symptoms, malabsorption due to mucosal inflammation, growth hormone (GH) resistance due to inflammation, and even genetic factors. Several population-based studies and cohort studies suggest that patients with pre-pubertal onset CD have a higher risk of growth failure at disease onset. Final adult height is still lower than that of healthy controls; however, its prevalence is generally lower than that at the disease onset. Several IBD treatments were reported to improve patients' growth. In addition to enteral nutrition therapy, treatment with anti-tumor necrosis factor (TNF) agents was reported to have favorable effects on growth of patients with pre-pubertal onset CD. Avoiding corticosteroids (CS) and achieving deep remission seems to be important to maintain optimal growth in patients with pediatric onset IBD.
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