Growth, course, and prognosis after surgery for Crohn's disease in children and adolescents

Surgery is often performed because of growth failure when Crohn's disease occurs in children and adolescents, but the long-term responses of such therapy are not known. Thirty-seven children and adolescents were followed from 2 to 26 years after resections for Crohn's disease. Twenty-eight patients had disease that involved both the colon and terminal ileum; disease was limited to the small intestine in eight patients and to the stomach in one. At the time of surgery 16 patients were at or below the third percentile for weight and only 16 had reached puberty (all of these were older than 14.5 years). Fourteen patients (11 prepubertal, 3 pubertal) had severe impairment of linear growth; height and was at or below the third percentile or linear growth was absent for more than a year. At the time of the first operation, seven patients had incomplete resections and have had persistent disease. The remaining 30 patients had complete resections as determined by gross and histological criteria. Of these, 12 have had recurrences and 18 have been free of disease. Of the 11 prepubertal patients with preoperative linear growth failure, only two had catch-up growth after surgery. The remaining nine and all of the pubertal patients have either failed to grow or have maintained their height in their preoperative percentile. Catch-up growth after surgery for Crohn's disease occurs only in those children who are operated on before puberty and in whom there is no early recurrence. The recurrence rate for this group of patients was 30%; most recurrences occurred within two years of the initial resection. Growth failure, therefore, may be considered an important indication for surgery in the prepubertal child with Crohn's disease, but it probably is not an indication after onset of puberty.