Growth in children receiving contemporary disease specific therapy for Crohn's disease

Abstract

Introduction: It is unclear whether recent therapeutic advances have improved the growth of children with Crohn's disease (CD).

Aim: 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.

What this study adds: 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).

Conclusion: 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.