REVIEWS Growth problems in children with IBD Ian R. Sanderson Abstract | Crohn’s disease in childhood causes linear growth retardation, which has a substantial effect on management of this disease. By contrast, growth is rarely a problem in children presenting with ulcerative colitis. Depending on how growth failure is defined, approximately one-third of children with Crohn’s disease have growth retardation at diagnosis. Although corticosteroids can suppress growth, decreased height at diagnosis demonstrates that this finding is a consequence of the disease and not merely an adverse effect of treatment. Both inflammation and undernutrition contribute to decreased height velocity. Increased cytokine production acts both on the hepatic expression of insulin-like growth factor 1 (IGF‑1) and at chondrocytes of the growth plates of long bones. Growth hormone insensitivity caused by deranged immune function is a major mechanism in growth retardation. Resolution of inflammation is the cornerstone of treatment, but current studies on growth hormone and IGF‑1 might yield therapies for those children whose inflammation is refractory to treatment. Sanderson, I. R. Nat. Rev. Gastroenterol. Hepatol. advance online publication 24 June 2014; doi:10.1038/nrgastro.2014.102
Introduction IBD comprises Crohn’s disease, indeterminate colitis, ulcerative colitis and rare (mostly genetic) conditions of early infancy.1,2 Growth failure is a particular problem in children with Crohn’s disease. One-quarter of cases of Crohn’s disease now present in children under 18 years3 and childhood incidence is increasing.4,5 Children are prone to a similar (although often more extensive6) array of characteristic features as adults, with the addition of growth retardation and delayed puberty.7 These two additional features affect the long-term outcomes of children with Crohn’s disease and their quality of life. Approximately one-third of children with Crohn’s disease experience linear growth retardation, caused by under nutrition and the direct effects of inflammation.8 However, the definition of growth retardation varies. A height or height velocity of two or more standard deviations below the mean for age (a standard deviation score [SDS] of
Introduction IBD comprises Crohn’s disease, indeterminate colitis, ulcerative colitis and rare (mostly genetic) conditions of early infancy.1,2 Growth failure is a particular problem in children with Crohn’s disease. One-quarter of cases of Crohn’s disease now present in children under 18 years3 and childhood incidence is increasing.4,5 Children are prone to a similar (although often more extensive6) array of characteristic features as adults, with the addition of growth retardation and delayed puberty.7 These two additional features affect the long-term outcomes of children with Crohn’s disease and their quality of life. Approximately one-third of children with Crohn’s disease experience linear growth retardation, caused by under nutrition and the direct effects of inflammation.8 However, the definition of growth retardation varies. A height or height velocity of two or more standard deviations below the mean for age (a standard deviation score [SDS] of
