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Growth Delay in Inflammatory Bowel Diseases: Significance, Causes, and Management
Kerry Wong1, Daniela Migliarese Isaac2, Eytan Wine3
1Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, Stollery Children's Hospital, Room 4-577, 11405 87th Avenue NW, Edmonton, AB, T6G 1C9, Canada.
Insights
Pediatric inflammatory bowel diseases (PIBD) significantly impact growth, causing height and weight impairment. Optimal disease control and a multidisciplinary approach are crucial for managing growth delay in these children.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Endocrinology
- Inflammatory Bowel Disease Research
Background:
- Growth delay, including height and weight impairment, is prevalent in pediatric inflammatory bowel diseases (PIBD), affecting up to two-thirds of Crohn's disease patients.
- Ulcerative colitis also impacts growth, and untreated delay can lead to reduced adult height, bone mass, and pubertal delay.
Purpose of the Study:
- To review the multifactorial mechanisms of growth delay in PIBD.
- To outline current management strategies for growth delay in PIBD.
- To identify potential pitfalls and areas for future research in managing PIBD-related growth issues.
Main Methods:
- Literature review of growth delay in pediatric inflammatory bowel diseases.
- Analysis of contributing factors including nutrient intake, absorption, inflammation, and treatment modalities.
- Examination of management strategies such as exclusive enteral nutrition, biologics, and corticosteroids.
Main Results:
- Growth delay in PIBD is multifactorial, stemming from reduced nutrient intake, malabsorption, inflammation, and treatments.
- Effective management hinges on optimal disease control, with exclusive enteral nutrition and biologics showing positive impacts on growth and bone development.
- A multidisciplinary approach involving nutritional rehabilitation and specialist services is essential for comprehensive care.
Conclusions:
- Optimal disease control is paramount for addressing growth delay in PIBD.
- Exclusive enteral nutrition and biologic therapies are key induction strategies that promote growth and bone health.
- A coordinated, multidisciplinary approach is necessary to effectively manage growth and pubertal delays in pediatric patients with IBD, despite ongoing challenges.
Abstract:
Growth delay with height and weight impairment is a common feature of pediatric inflammatory bowel diseases (PIBD). Up to 2/3 of Crohn Disease patients have impaired weight at diagnosis, and up to 1/3 have impaired height. Ulcerative colitis usually manifests earlier with less impaired growth, though patients can be affected. Ultimately, growth delay, if not corrected, can reduce final adult height. Weight loss, reduced bone mass, and pubertal delay are also concerns associated with growth delay in newly diagnosed PIBD patients. The mechanisms for growth delay in IBD are multifactorial and include reduced nutrient intake, poor absorption, increased fecal losses, as well as direct effects from inflammation and treatment modalities. Management of growth delay requires optimal disease control. Exclusive enteral nutrition (EEN), biologic therapy, and corticosteroids are the primary induction strategies used in PIBD, and both EEN and biologics positively impact growth and bone development. Beyond adequate disease control, growth delay and pubertal delay require a multidisciplinary approach, dependent on diligent monitoring and identification, nutritional rehabilitation, and involvement of endocrinology and psychiatry services as needed. Pitfalls that clinicians may encounter when managing growth delay include refeeding syndrome, obesity (even in the setting of malnutrition), and restrictive diets. Although treatment of PIBD has improved substantially in the last several decades with the era of biologic therapies and EEN, there is still much to be learned about growth delay in PIBD in order to improve outcomes.
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