Growth in children receiving contemporary disease specific therapy for Crohn's disease.
BACKGROUND
It is unclear whether recent therapeutic advances have improved the growth of children with Crohn's disease (CD).


OBJECTIVE
To assess the frequency of short stature and poor growth and their relationship to disease course and therapy in children with CD.  WHAT IS ALREADY KNOWN ON THIS TOPIC: Growth retardation may occur in children with Crohn's disease (CD).  Current therapy for CD in the UK is less likely than previously to involve the use of long-term glucocorticoids.


CONCLUSIONS
Despite advances in therapy, short stature and slow growth continue to be encountered in children with CD.  There is a need for simple and consistent definitions of growth that can identify poor growth in children with chronic disease.


METHODS
The anthropometric and treatment details of 116 children (68 male) with a mean (range) age at diagnosis of 10.8 years (4.9-15.5) and a mean age at maximum follow-up (MF) of 15.4 years (9.4-19.3) were studied retrospectively at diagnosis (T0), at 1 (T1), 2 (T2) and 3 years (T3) after diagnosis and at MF.


RESULTS
At T0, mean height SD score (HtSDS) was -0.5 (-3.3 to 2.6) compared to a mid-parental HtSDS of 0.2 (-2.0 to 01.4) (p=0.002). At T1, T2, T3 and MF, mean HtSDS was -0.6 (-4.8 to 7.8), -0.6 (-2.9 to 2.2), -0.7 (-3.6 to 2.5) and -0.5 (-3.5 to 2.9), respectively. Mean Ht velocity (HV) SDS at T1, T2, T3 and MF was -1.4 (-7.4 to 7.4), -0.6 (-7.5 to 6.1), -0.1 (-6.6 to 7.6) and 0.6 (-4.8 to 7.8), respectively (p<0.05). In final models, HtSDS was associated negatively with the use of prednisolone (p=0.0001), azathioprine (p=0.0001), methotrexate (p=0.0001) and weight SDS (WtSDS) (p=0.0001). HVSDS was associated positively with age (p=0.0001) and WtSDS (p=0.01). ΔHtSDS was associated negatively with use of prednisolone (p<0.02).


CONCLUSIONS
Although current therapy for CD is associated with improved rate of growth for the first few years, a substantial proportion of children remain short. This study also highlights the need for consistency in describing growth in children with chronic diseases.
Department of Child Health, University of Glasgow, Bone and Endocrine Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Salma
S
Malik
Avril
A
Mason
Andisheh
A
Bakhshi
David
D
Young
Jonathan
J
Bishop
Victoria
V
Garrick
Paraic
P
McGrogan
Richard K
RK
Russell
S Faisal
SF
Ahmed
D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use; D001827:Body Height / Q000187:drug effects / Q000502:physiology*; D002648:Child; D002657:Child Development / Q000187:drug effects / Q000502:physiology*; D002675:Child, Preschool; D003424:Crohn Disease / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D011627:Puberty / Q000187:drug effects / Q000502:physiology*; D012189:Retrospective Studies; D055815:Young Adult
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011239:Prednisolone; D001379:Azathioprine; D008727:Methotrexate