Crohn's disease and growth deficiency in children and adolescents

Table 3 Summary of the main studies that were reviewed on management of growth and pubertal issues in pediatric Crohn’s disease

Ref.	Type of study	Patients	Results	Conclusion
Mason et al[66] Horm Res Paediatr 2011	Retrospective cohort study	IBD adolescents 41 with CD, 30 M 11 F 26 with UC, 14 M 12 F	Altered parameters of pubertal growth observed in the CD groups compared to the normal population: In the CD M group, median Ht at Dg was -0.56 (P = 0.001) and median age at peak Ht velocity was 14.45 yr (P = 0.004) In the CD F group, median Ht at Dg was -1.14 (P = 0.007) and Ht at peak Ht velocity was -0.79 (P = 0.039). Individually, 8/30 CD M cases had one or more parameter affected: In the whole group, age at peak Ht velocity showed an association with ESR (r = 0.4; P = 0.005) and an inverse association with BMI (r = 0.4; P = 0.001)	Disorders of pubertal growth are more likely to occur in CD (particularly M)
Tietjen et al[69] Turk J Gastroenterol 2009	Prospective cohort study	40 pts with CD 26 M, 14 F mean age 16,7 yr (median: 17 yr, range: 4-29 yr)	Urinary GH levels were found as normal in CD; Corticosteroid therapy did not appear to be the most responsible factor for growth failure in CD	Growth failure in patients with CD is not caused by GH deficiency; A high PCDAI score has an important impact on impaired growth in children and adolescents with CD
Wong et al[70] J Pediatr Endocrinol Metab 2007	Retrospective data analysis	7 pts with CD 5 M	Median chronological age and median difference between chronological age and bone age was 15.9 yr (range, 13.0-17.9 yr) and 1.7 yr (-0.7-3.3 yr), respectively; Median dose of rhGH at T+0 was 0.23 mg/wk (0.15-0.31); Pubertal status remained unchanged in 6/7 patients; Median albumin and C-reactive protein were similar at T+0 and T+6; Median height SDS at T+0, T+6 and T+12 was -2.2 (-4.0 to -1.5), -1.9 (-4.1 to -0.8), -1.9 (-4.1 to -0.7), respectively (NS). Median Ht velocity SDS at T+0 and T+6 was -2.5 (-4.8-1.4) and -0.9 (-5.3 to 3.4), respectively (NS); Positive correlation between percentage change in Ht velocity SDS at T+6 and dose of rhGH at T+0 (r = 0.8, P = 0.03)	Introduction of rhGH therapy was associated with a cessation in the deterioration in linear growth; An improvement in Ht SDS was not observed over the period of the study
Wong et al[71] Clin Endocrinol (Oxf) 2011	Randomized controlled trial in 2 tertiary Children's Hospitals	22 children with IBD 21 with CD	Median Ht velocity increased from 4.5 (range, 0.6-8.9) at baseline to 10.8 (6.1-15) cm/year at 6 mo (P = 0.003) in the rhGH group, whereas in the Ctrl group, it was 3.8 (1.4-6.7) and 3.5 cm/yr (2-9.6), respectively (P = 0.58); Median percentage increase in Ht velocity after 6 mo in the rhGH group was 140% (16.7%-916.7%) compared with 17.4% (-42.1%-97.7%) in the Ctrl group (P < 0.001). No significant differences in disease activity and proinflammatory cytokines at baseline and 6 mo in both groups	rhGH can improve short-term linear growth in children with CD; The clinical efficacy of this therapy needs to be further studied in longer-term studies of growth, glucose homeostasis, and disease status

Dg: Diagnosis; pt/pts: Patient/patients; CD: Crohn’s disease; UC: Ulcerative Colitis; IBD-U: Unclassified IBD; rhGH: Recombinant growth factor; ESR: Erythrocyte sedimentation rate; BMC: Body cell mass; BMI: Body mass index; Ht: Height; Wt: Weight; BMD: Bone mineral density; DXA: Dual-energy X-ray absorptiometry; EEN: Exclusive enteral nutrition; GH: Growth hormone; (P)CDAI: (Pediatric) Crohn’s disease activity index; PUCAI: Pediatric ulcerative colitis activity index; M: Male; F: Female; NS: Not significant.