Controlled Ileal Release Budesonide in Pediatric Crohn Disease: Efficacy and Effect on Growth

Kundhal, Pavi S.; Zachos, Mary; Holmes, Jordan; Griffiths, Anne M.

doi:10.1097/00005176-200107000-00013

Cited by 52 publications

(17 citation statements)

References 34 publications

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“…Budenoside, although less effective than prednisone, should only be considered in mild to moderate pediatric CD with terminal ileal and right colonic involvement [58,59]. Kundhal et al [60] assessed the effects on growth of a 6-month administration of pH-dependent controlled ileal release budesonide in 6 prepubertal children with CD of the terminal ileon ± right colon. Despite weight gain and almost absence of gastrointestinal symptoms, linear growth was low in all children and even decreased when compared to the 6-month pretreatment period [60].…”

Section: Resultsmentioning

confidence: 99%

“…Kundhal et al [60] assessed the effects on growth of a 6-month administration of pH-dependent controlled ileal release budesonide in 6 prepubertal children with CD of the terminal ileon ± right colon. Despite weight gain and almost absence of gastrointestinal symptoms, linear growth was low in all children and even decreased when compared to the 6-month pretreatment period [60]. Currently, it is not possible to assess whether growth retardation under budesonide therapy is due to a glucocorticoid-suppressive effect on growth, an insufficiently controlled inflammation, or both.…”

Section: Resultsmentioning

confidence: 99%

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Impact of Disease and Treatments on Growth and Puberty of Pediatric Patients with Inflammatory Bowel Disease

Ezri¹,

Marques‐Vidal²,

Nydegger³

2012

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Impact of Disease and Treatments on Growth and Puberty of Pediatric Patients with Inflammatory Bowel Disease

Ezri¹,

Marques‐Vidal²,

Nydegger³

2012

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“…Moreover, clinical response to corticosteroids in CD is often not associated with mucosal healing [32] , leading to continued cytokine interference with linear growth. Similarly, limited reported experience with controlled ileal release budesonide in children with CD involving the ileum 8 right colon suggests that height velocity is impaired despite control of symptoms [33] .…”

Section: Treating To Facilitate Growthmentioning

confidence: 99%

Growth Retardation in Early-Onset Inflammatory Bowel Disease: Should We Monitor and Treat These Patients Differently?

Griffiths

2009

Dig Dis

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Growth impairment and associated pubertal delay are common complications of pediatric inflammatory bowel disease (IBD), particularly Crohn’s disease (CD). Chronic undernutrition (related primarily to inadequate intake) and pro-inflammatory cytokines are the two major and interrelated contributory factors. Pathogenic mechanisms include interference with growth hormone/insulin-like growth factor-1 axis, with gonadotropin-releasing hormone secretion patterns, and direct cytokine effects on growing bone. Chronic corticosteroid therapy compounds disease-related causes of growth impairment. The influence on growth of polymorphisms in IBD susceptibility or modifier genes is under study. Accurate recognition of impaired growth requires appreciation of normal growth. Pre-illness standard deviation scores (SDS) for height should be obtained and compared with height SDS at diagnosis, so that the impact of disease on growth can be fully appreciated. The greater the deficit prior to recognition of IBD, the greater is the demand for catch-up growth. Height velocity should be regularly monitored and its adequacy for age and pubertal stage assessed. Restoration and maintenance of pre-illness growth pattern indicate success of therapy. Current treatment regimens limit use of corticosteroids, via optimization of immunomodulatory drugs, use of enteral nutrition in CD, and, if necessary, surgery for ulcerative colitis and for intestinal complications of localized CD. Biologic agents with the potential for mucosal healing hold promise of growth enhancement even among children, whose growth with previously available therapies remained compromised. For all therapies, there is a window of opportunity to achieve normal growth before puberty is too advanced.

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“…Glucocorticoids also act at the growth plate level altering GH receptor expression and IGF-1 binding [75] (Figure 1). Even glucocorticoids with low systemic activity such as budesonide, used for remission induction in mild to moderate CD patients, appear to suppress linear growth [76]. Nevertheless it is impossible to isolate the effect of corticosteroids treatment on growth weighing its anti-inflammatory properties against its described impact on GH/IGF-1 axis and on the growth plates.…”

Section: Corticosteroids Effectmentioning

confidence: 99%

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

Shamir¹

2014

J Clin Cell Immunol

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Growth retardation is a common complication of pediatric inflammatory bowel disease (IBD), which may have long term effects on final adult height and carries significant social and psychological implications. Etiology may be multifactorial including undernutrition, metabolic dysregulation, inflammatory impact on hormonal growth axis and the effect of drugs such as glucocorticoids. Control of disease activity and minimizing the need for corticosteroid therapy are necessary measures in order to facilitate normal growth. However, in many cases these strategies are not sufficient. Currently, there is inconsistent evidence regarding the efficacy of available therapeutic agents to induce long-term effect on growth. The new era of biologic therapies which carries a greater potential to achieve mucosal healing, holds promise for better growth even in children with severe growth impairment. It becomes apparent that prompt recognition of growth impairment combined with aggressive tailored therapeutic approach may offer the best chance for catch-up growth. This review will discuss the definition, prevalence and mechanism of growth retardation in children with IBD and highlight the specific benefits of current therapeutic strategies.

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Controlled Ileal Release Budesonide in Pediatric Crohn Disease: Efficacy and Effect on Growth

Cited by 52 publications

References 34 publications

Impact of Disease and Treatments on Growth and Puberty of Pediatric Patients with Inflammatory Bowel Disease

Impact of Disease and Treatments on Growth and Puberty of Pediatric Patients with Inflammatory Bowel Disease

Growth Retardation in Early-Onset Inflammatory Bowel Disease: Should We Monitor and Treat These Patients Differently?

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

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