Growth Abnormalities Persist in Newly Diagnosed Children With Crohn Disease Despite Current Treatment Paradigms

Abstract

Growth delay persists in many children with CD following diagnosis, despite improved disease activity and the frequent use of immunomodulators and biologics. Additional strategies to improve growth outcomes require development.

Health Care Maintenance for the Pediatric Patient With Inflammatory Bowel Disease

“…However, growth delays often persist after diagnosis despite improvement in inflammatory biomarkers and treatment with biologic agents. 8,9 Therefore, failure to control inflammation puts this population at increased risk for fracture. The International Society for Clinical Densitometry recommends that children with IBD undergo a total body (excluding the skull) dualenergy radiograph absorptiometry (DXA) screen at diagnosis and at 6-month intervals if abnormalities are found.…”

Characteristics of clinical presentation of 146 cases of newly diagnosed paediatric onset Crohn’s disease

“…Typowe objawy, takie jak: bóle brzucha, wzdęcia, biegunki z krwawieniem lub bez (jawnym bądź utajonym), ubytek masy ciała, mogą pojawić się jednocześnie lub po pewnym czasie trwania choroby. Unikalnym problemem w porównaniu z dorosłymi, który wymaga szczególnej uwagi u pacjentów w wieku rozwojowym, jest zahamowanie wzrostu i opóźnienie dojrzewania płciowego [10,11]. Na obraz kliniczny choroby wpływa nie tylko lokalizacja czy charakter zmian zapalnych, ale także aktywność stanu zapalnego.…”

Impact of Therapeutic Strategies on Growth in Pediatric Inflammatory Bowel Disease

“…In contrast, Sinitsky et al [121] reported a significant improvement in BMI z-score at one year of treatment with IFX in children with CD but failed to show significant changes in height velocity. Pfefferkorn et al [4] did find an improvement in height velocity z-scores during the first two years following diagnosis of CD though no difference between therapy regimens was noted. This discrepancy could be attributed to a relatively advanced pubertal stage in the first study and to heterogeneity in therapeutic regimens in the second one.…”

“…Anti-TNF agents have a promising potential for improving growth as they were shown to induce prompt mucosal healing [110,111], reverse the pro-inflammatory cytokines cascade [113] and enable prolonged corticosteroid withdrawal [108][109][110]. Indeed, numerous studies suggest an increase in height velocity and height z-score following prolonged anti-TNF treatment, providing treatment is undertaken early enough prior to or during puberty [4,106,111,112,[114][115][116][117][118][119][120]. In contrast, Sinitsky et al [121] reported a significant improvement in BMI z-score at one year of treatment with IFX in children with CD but failed to show significant changes in height velocity.…”

“…The rate of growth impairment in pediatric IBD at diagnosis varies with the type of disease (CD vs. ulcerative colitis [UC]), gender, and the time of diagnosis [3][4][5][6][7][8][9][10][11]. Apparently, the age and pubertal stage at diagnosis are key factors for growth potential.…”