Impact of disease and treatments on growth and puberty of pediatric patients with inflammatory bowel disease.
Growth retardation, associated with delayed puberty, is a frequent feature in pediatric patients with inflammatory bowel disease (IBD), especially with Crohn's disease. It is mainly induced by malnutrition and the effects of the inflammatory process on the growth hormone/insulin-like growth factor-1 axis or on the growth plate. Therefore, control of disease activity and mucosal healing are paramount to promote growth and adequate pubertal onset. Current therapeutic strategies for maintenance in IBD include anti-inflammatory drugs, immunosuppressives, and, more recently, biologic agents. Although these treatments are efficient in minimizing inflammation and inducing prolonged remission, their long-term effects on growth and final height remain controversial. Furthermore, glucocorticoid therapy, even though very efficient in inducing remission, clearly shows deleterious effects on growth, which is not the case for exclusive enteral nutrition showing comparable results regarding induction of remission. Thus regular assessment of weight, height and pubertal stage is essential in children and adolescents with chronic disease, namely IBD.
Pediatric Gastroenterology Unit, Department of Pediatrics, University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Jessica
J
Ezri
Pedro
P
Marques-Vidal
Andreas
A
Nydegger
D000293:Adolescent; D002648:Child; D004750:Enteral Nutrition; D005938:Glucocorticoids / Q000009:adverse effects*; D006130:Growth Disorders / Q000209:etiology* / Q000378:metabolism; D013006:Growth Hormone / Q000378:metabolism; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007249:Inflammation / Q000150:complications / Q000209:etiology / Q000378:metabolism; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy* / Q000378:metabolism; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D044342:Malnutrition / Q000150:complications / Q000209:etiology / Q000378:metabolism; D011628:Puberty, Delayed / Q000209:etiology* / Q000378:metabolism
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone