Growth in children receiving contemporary disease specific therapy for Crohn's disease
- Salma Malik1,2,
- Avril Mason1,
- Andisheh Bakhshi3,
- David Young4,
- Jonathan Bishop2,
- Victoria Garrick2,
- Paraic McGrogan2,
- Richard K Russell2,
- S Faisal Ahmed1
- 1Department of Child Health, University of Glasgow, Bone and Endocrine Research Group, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
- 2Department of Paediatric Gastroenterology and Nutrition, University of Glasgow, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
- 3School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
- 4Department of Statistics and Modelling Science, University of Strathclyde, Glasgow, UK
- Correspondence to Professor S Faisal Ahmed, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK;
Contributors SM, SFA and RKR designed the study; SM was study coordinator; AM, JB, VG, PM, RKR and SFA identified patients for the study; SM, AB, DY and SFA performed data analysis; SM, RKR and SFA wrote the manuscript and all authors reviewed it and agreed on the final version.
- Received 2 August 2011
- Accepted 10 April 2012
- Published Online First 9 June 2012
Introduction It is unclear whether recent therapeutic advances have improved the growth of children with Crohn's disease (CD).
Aim To assess the frequency of short stature and poor growth and their relationship to disease course and therapy in children with CD.
What is already known on this topic
Growth retardation may occur in children with Crohn's disease (CD).
Current therapy for CD in the UK is less likely than previously to involve the use of long-term glucocorticoids.
What this study adds
Despite advances in therapy, short stature and slow growth continue to be encountered in children with CD.
There is a need for simple and consistent definitions of growth that can identify poor growth in children with chronic disease.
Methods The anthropometric and treatment details of 116 children (68 male) with a mean (range) age at diagnosis of 10.8 years (4.9–15.5) and a mean age at maximum follow-up (MF) of 15.4 years (9.4–19.3) were studied retrospectively at diagnosis (T0), at 1 (T1), 2 (T2) and 3 years (T3) after diagnosis and at MF.
Results At T0, mean height SD score (HtSDS) was −0.5 (−3.3 to 2.6) compared to a mid-parental HtSDS of 0.2 (−2.0 to 01.4) (p=0.002). At T1, T2, T3 and MF, mean HtSDS was −0.6 (−4.8 to 7.8), −0.6 (−2.9 to 2.2), −0.7 (−3.6 to 2.5) and −0.5 (−3.5 to 2.9), respectively. Mean Ht velocity (HV) SDS at T1, T2, T3 and MF was −1.4 (−7.4 to 7.4), −0.6 (−7.5 to 6.1), −0.1 (−6.6 to 7.6) and 0.6 (−4.8 to 7.8), respectively (p<0.05). In final models, HtSDS was associated negatively with the use of prednisolone (p=0.0001), azathioprine (p=0.0001), methotrexate (p=0.0001) and weight SDS (WtSDS) (p=0.0001). HVSDS was associated positively with age (p=0.0001) and WtSDS (p=0.01). ΔHtSDS was associated negatively with use of prednisolone (p<0.02).
Conclusion Although current therapy for CD is associated with improved rate of growth for the first few years, a substantial proportion of children remain short. This study also highlights the need for consistency in describing growth in children with chronic diseases.
Competing interests None.
Funding SM is funded by the University of Balochistan Higher Education Commission of Pakistan. RKR is supported by an NHS Research Scotland career fellowship award and received support from a Medical Research Council (MRC) patient research cohorts initiative grant (G0800675) for PICTS. The IBD team at Yorkhill, Glasgow is supported by the Catherine McEwan Foundation and the Yorkhill IBD fund.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data from this retrospective study are available for sharing and audit.