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Growth impairment in Japanese children with inflammatory bowel disease: A multicenter prospective cohort study
Hirotaka Shimizu1, Ryusuke Nambu2, Nao Tachibana3
1Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan.
Insights
Growth impairment (GI) affects children with inflammatory bowel disease (IBD), particularly young ulcerative colitis (UC) patients. Early, steroid-sparing treatment and tailored monitoring are key for better outcomes in pediatric IBD.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Growth and Development Studies
Background:
- Growth impairment (GI) is a significant concern in pediatric inflammatory bowel disease (IBD).
- Understanding the distinct characteristics and prevalence of GI in ulcerative colitis (UC) and Crohn's disease (CD) is crucial for effective management.
- Early identification and intervention are vital for optimizing long-term health outcomes in affected children.
Purpose of the Study:
- To investigate the prevalence and specific characteristics of growth impairment (GI) in children diagnosed with IBD.
- To compare growth patterns and recovery rates between children with UC and CD.
- To identify risk factors and vulnerable subgroups within the pediatric IBD population.
Main Methods:
- A prospective observational study involving 402 children with UC (n=257) and CD (n=145) from the Japanese Pediatric IBD Registry (2012-2020).
- Growth impairment (GI) was defined using the Paris classification criteria.
- Longitudinal outcomes were assessed for 307 children with at least two years of follow-up.
Main Results:
- At diagnosis, GI prevalence was similar between UC (6.2%) and CD (8.3%).
- Children with UC diagnosed at 0-4 years showed significantly higher GI rates (35.3%).
- Growth recovery at 2 years was lower in UC (9%) compared to CD (50%) among those with initial GI. New-onset GI occurred in 23% of UC and 16% of CD cases, with persistent GI noted in 16% of UC and 11% of CD cases. Prolonged corticosteroid use was linked to persistent GI in UC.
Conclusions:
- Distinct growth patterns are observed in Japanese children with IBD, with younger UC patients being particularly vulnerable.
- Small intestinal lesions are associated with GI in CD, highlighting the need for thorough small bowel evaluation.
- Age-specific, patient-centered growth monitoring and early, steroid-sparing strategies are essential for improving long-term outcomes in pediatric IBD.
Objectives:
To investigate the prevalence and characteristics of growth impairment (GI) in children with inflammatory bowel disease (IBD).
Methods:
In this prospective observational study, 402 children with ulcerative colitis (UC, n = 257) and Crohn's disease (CD, n = 145) were enrolled from the Japanese Pediatric IBD Registry (2012-2020). GI was defined by Paris classification criteria. Longitudinal outcomes were assessed in children with ≥2 years of follow-up (n = 307).
Results:
At diagnosis, the GI prevalence was comparable between children with UC and CD (6.2% vs. 8.3%, p = 0.54). However, children with UC diagnosed at 0-4 years demonstrated significantly higher GI rates (35.3%) than older children (p < 0.001). All children with CD experiencing GI had small intestinal lesions. Among those with GI at diagnosis, fewer children with UC (9%) recovered growth at a 2-year follow-up than those with CD (50%). Among children with normal growth at baseline, new-onset GI occurred in 23% of UC and 16% of CD cases. Of these, 31% recovered within 2 years, while persistent GI was observed in 16% of UC and 11% of CD cases. Prolonged corticosteroid use at 1 year was more frequent in UC (31% vs. 19%, p = 0.02) and was significantly associated with persistent GI.
Conclusions:
Distinct growth patterns exist in Japanese children with IBD. Children with UC diagnosed at 0-4 years are particularly vulnerable and may benefit from early, steroid-sparing treatment. The association between small intestinal lesions and GI in CD emphasizes the importance of small bowel evaluation. Age-specific, patient-centered growth monitoring is crucial to optimize long-term outcomes.
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