Growth problems in children with IBD

Key Points

  • Depending on the definition used, growth retardation occurs in approximately one-third of children presenting with Crohn's disease

  • Low energy intake and direct effects of inflammation contribute to low height velocity

  • Compared with the whole paediatric population with Crohn's disease, children carrying Crohn's susceptibility genes do not have increased risk of growth retardation

  • Inflammatory mediators affect growth by causing growth hormone resistance; resistance is caused by IL-6 and TNF impairing hepatic growth hormone signal transduction and by inhibiting cell proliferation at the growth plate

  • Medical or surgical resolution of inflammation is the cornerstone of growth retardation treatment; treating inflammation with infliximab or by resection has little efficacy in late puberty (Tanner stage IV or beyond)

  • Preliminary studies are being carried out on the use of growth hormone and insulin-like growth factor 1 treatment for children whose inflammation proves intractable to medical or surgical intervention

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.

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Figure 1: The growth hormone–IGF-1 axis regulates linear growth.
Figure 2: Effects of inflammation and undernutrition on linear growth retardation.
Figure 3: Effect of infliximab therapy on height in children with Crohn's disease.

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Acknowledgements

The work of the author is supported by grants from the National Institutes of Health (P30-DK040561), Crohn's and Colitis Foundation of America (1774) and the Crohn's in Childhood Research Association. The author is grateful to N. Croft, S. Naik and D. van Heel for their comments on the manuscript.

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Sanderson, I. Growth problems in children with IBD. Nat Rev Gastroenterol Hepatol 11, 601–610 (2014). https://doi.org/10.1038/nrgastro.2014.102

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