Adult height in patients with early onset of Crohn's disease

Abstract

We read with great interest the recently published guidelines on the management of osteoporosis associated with chronic liver disease (Gut 2002;50(suppl I):i1-9). However, we would like to add a few words of comment. Associations between coeliac disease (CD) and primary biliary cirrhosis in particular and other autoimmune liver diseases in general have been reported. 1-3 In addition, it has been suggested that these individuals should be considered as an at risk group for whom serological testing for CD is indicated. 1 Patients with CD are at high risk of developing low bone mineral density and bone turnover impairment, 1 and it has been shown that adherence to a gluten free diet has a significant positive impact on these parameters. 4 Thus we suggest that physicians caring for patients with the above mentioned liver diseases should screen them for CD in the presence of signs and symptoms suggestive of malabsorption such as osteoporosis. This seems a reasonable strategy as detection of CD will allow for a more rational therapeutic approach to the risks determined by this association. Complications due to the presence of CD, such as malnutrition, anaemia, and osteoporosis, may have a considerable impact on liver disease management and the need/success of transplantation. 5 6

The restricted potential for recovery of growth plate chondrogenesis and longitudinal bone growth following exposure to pro-inflammatory cytokines

“…In children with juvenile idiopathic arthritis, high-dose treatment with GH leads to a rise in systemic levels of IGF-I and has been reported to reduce the worsening growth retardation but does not seem to result in normalisation of height (Simon et al 2003). Furthermore, several studies of final height of adults with childhood onset inflammatory bowel disease show that these adults may be relatively short (Castile et al 1980, Griffiths et al 1993, Markowtiz et al 1993, Alemzadeh et al 2002, Sawczenko et al 2003. Our data would suggest that even a relatively short period of exposure to pro-inflammatory cytokines, especially when in combination, may have an irreversible effect on growth plate chondrogenesis.…”

“…Although this may be a transient phenomenon that is dependent on the resolution of the above factors (Kirscher et al 1981), there are some concerns that it may also result in permanent growth restriction (Sawczenko et al 2003). Although cytokines may affect growth through systemic mechanisms that alter GH secretion (Mainardi et al 2002), growth disorders in chronic inflammatory disease may also be due to a direct effect of cytokines at the level of the growth plate (de Hooge et al 2003, Martensson et al 2004).…”

Can We Change the Natural History of Crohn's Disease with Early Immunomodulation?

“…Early studies documented deficits in height velocity in up to 88% of children at diagnosis [24] and diminished height percentiles for age or height z-scores in 36-65% of children with CD [25,26,27]. Ongoing growth impairment after diagnosis was common, with rates of permanent stunting at final adult height reported in 19-37% of children diagnosed with CD before puberty [28,29,30]. Factors associated with the impairment in growth include the growth-suppressive effects of proinflammatory cytokines, poor nutritional intake, and exposure to corticosteroid therapy [31,32,33,34,35].…”

A Prospective Longitudinal Study of Growth and Pubertal Progress in Adolescents with Inflammatory Bowel Disease

“…Pubertal delay is often associated with growth retardation but previous studies suggest that adolescents with IBD seem to have more profound short stature than expected simply for delayed puberty [1]. In addition, adults with a history of pubertal delay are often shorter as adults than their predicted height (Ht) but the discrepancy between target Ht and final Ht seems to be greater in adults with childhood onset IBD compared to healthy adults with a history of delayed puberty [7,8,9]. …”