Interventions for growth failure in childhood Crohn's disease

Newby, EA; Sawczenko, A; Thomas, AG; Wilson, David C.

doi:10.1002/14651858.cd003873

Cited by 40 publications

(59 citation statements)

References 19 publications

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“…Typically children with IBD grow more slowly before diagnosis and when disease is active. Growth retardation has been reported in 15% to 40% of children with IBD [18]. Decreased height velocity may be the earliest indicator preceding the diagnosis of CD.…”

Section: Impaired Growth and Development And Impact Of Chronic Steroimentioning

confidence: 99%

“…In pediatric patients with IBD treated with glucocorticoids, there is also a higher incidence of osteoporosis, glaucoma, and cataracts compared to adult patients [19]. Steroid sparing agents, such as 6-mercaptopurine may prevent growth retardation associated with chronic steroid use [18]. Mercaptopurine and its prodrug, azathioprine, are effective in maintaining remission in children with CD and may improve growth velocity and final adult height by controlling the disorder and sparing the child long term glucocorticoid treatment [20].…”

Section: Impaired Growth and Development And Impact Of Chronic Steroimentioning

confidence: 99%

See 1 more Smart Citation

Late Consequences of Chronic Pediatric Illness

Turkel

Pao

2007

Psychiatric Clinics of North America

118

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Section: Impaired Growth and Development And Impact Of Chronic Steroimentioning

confidence: 99%

Section: Impaired Growth and Development And Impact Of Chronic Steroimentioning

confidence: 99%

Late Consequences of Chronic Pediatric Illness

Turkel

Pao

2007

Psychiatric Clinics of North America

118

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“…In addition to the therapeutic effect (66) , nutritional therapy has positive effects on growth and development (67,68) and may reduce the use of corticosteroids (69) . A recent meta-analysis has concluded that enteral nutrition has similar efficacy to corticosteroids in children, but has cautioned that this outcome is based on limited data (66) .…”

Section: Childrenmentioning

confidence: 99%

“…A recent meta-analysis has concluded that enteral nutrition has similar efficacy to corticosteroids in children, but has cautioned that this outcome is based on limited data (66) . A Cochrane review of strategies for growth failure in children with CD has highlighted the positive effect of enteral nutrition therapy in promoting growth (68) . In children enteral nutrition is recommended as first-line therapy for active disease, especially for those with growth failure (Table 1).…”

Section: Childrenmentioning

confidence: 99%

Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ Nutrition in Crohn's disease

O’Sullivan

2009

Proc. Nutr. Soc.

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The exact aetiology of Crohn's disease remains unknown. The consensus is that the disease results from a complex interaction between genes, immunity and environmental factors. Diet is attractive, in theory, as an environmental risk factor in the aetiology of the disease. The epidemiological data, often impeded by methodological issues, have failed to confirm a direct link between pre-diet illness and the development of Crohn's disease. Once diagnosed, however, nutrition has an important role in disease management. Among the nutritional issues are malnutrition, weight loss and suboptimal nutritional status; these outcomes may be present at any stage of the disease but are likely to be overt during acute illness and hospitalisation. Malnutrition has been identified in approximately 40% of hospital admissions with Crohn's disease and is associated with higher mortality, longer hospital stays and higher healthcare costs. Patients in remission may indeed be overweight and appear to be influenced by the general population trends toward overweight and obesity. Irrespective of BMI, patients are at risk of micronutrient deficiencies. Vitamin D deficiency, for example, is common in Crohn's disease and has important implications for bone health. Moreover, newer evidence suggests that vitamin D has potential anti-inflammatory effects. Dietary approaches, in the form of enteral nutrition, have previously been shown to reduce inflammation and treat the active disease. Current guidelines now recommend that corticosteroids are more effective than enteral nutrition for treating adults. Enteral nutrition has important growth and developmental benefits and continues to be a recommended therapy for children with Crohn's disease.

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“…It is non-toxic and probably as effective as steroids (19,20) . A recent Cochrane review of growth failure in childhood Crohn's disease has examined the impact of different treatments on growth (21) and has concluded that there is some evidence that exclusive enteral nutrition has additional benefits on growth when compared with steroids. The evidence for effectiveness is supported by the clinical experience of advocates of enteral nutrition who see it as well tolerated, non-toxic and acceptable to patients.…”

Section: Nutritional Therapymentioning

confidence: 99%

Symposium 6: Young people, artificial nutrition and transitional care Nutrition, growth and puberty in children and adolescents with Crohn's disease

Beattie

2009

Proc. Nutr. Soc.

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Of the individuals who present with Crohn's disease 25% are <18 years of age, mostly adolescent. Nutritional impairment and delayed growth are common at diagnosis and remain an issue during the disease course. Treatment has the primary aim to control symptoms, induce disease remission and achieve normal growth in the long term and includes nutritional support and early use of immunomodulation. Puberty may be discordant and is generally late and final adult height may not be achieved until the late teenage years. Chronic ill health and delayed growth may be accompanied by emotional and intellectual immaturity. These factors, including the varying rates of physical and emotional development, need to be considered during adolescence with multidisciplinary input to ensure that the young patient is appropriately supported. Transition to adult care requires close collaboration between paediatric and healthcare teams with careful attention to nutritional, emotional and educational issues, all of which are relevant in the progression from childhood, through adolescence and to adult life.

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Interventions for growth failure in childhood Crohn's disease

Cited by 40 publications

References 19 publications

Late Consequences of Chronic Pediatric Illness

Late Consequences of Chronic Pediatric Illness

Session 3: Joint Nutrition Society and Irish Nutrition and Dietetic Institute Symposium on ‘Nutrition and autoimmune disease’ Nutrition in Crohn's disease

Symposium 6: Young people, artificial nutrition and transitional care Nutrition, growth and puberty in children and adolescents with Crohn's disease

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