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.
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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.