Growth and Puberty in Children with Inflammatory Bowel Diseases

Abstract

Inflammatory bowel diseases (IBD) are gastrointestinal tract pathologies of unknown etiology; they have an alternating trend, with active and silent phases. IBD are classified in two main forms: ulcerative colitis (UC) and Crohn's disease (CD). Both have chronic and recurrent course, gastrointestinal symptoms, and extraintestinal manifestations. The altered immune response role seems to be important both in UC and CD. In the majority of cases, CD begins with abdominal pain, diarrhea, decrease in appetite, and weight loss; there can be also perianal fistulas, rhagades, and perianal recurrent abscesses. In addition, retarded growth and delayed puberty can precede the development of the disease or can even be predominant at onset. Growth retardation is found in 40% of IBD patients, but the underlying mechanism of this and other extra-intestinal manifestations are partially known: the main hypotheses are represented by malnutrition and inflammatory response during the active phase of the disease. The increased level of pro-inflammatory cytokines can influence growth, but also the onset of puberty and its progression. In addition, it could be essential to clarify the role and the possible effects of all the currently used treatments concerning growth failure and delayed puberty.

Keywords: Crohn’s disease; delayed puberty; growth failure; ulcerative colitis.

Figure 1

The role of immune response in IBD: both UC and CD are characterized by the increased and sometimes massive production of IL-2, IL-12, IL-6, IFN-γ, IL-5, and IL-13. ILCs: Innate Lymphoid cells.

Figure 2

GH-IGF-1 axis: how growth hormone (GH) acts on target organs/tissues, leading to Insulin like Growth Factor-1 (IGF-1) production.