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Growth in children receiving contemporary disease specific therapy for Crohn's disease

Malik, S. and Mason, A. and Bakhshi, Andisheh and Young, David and Bishop, J. and Garrick, V. and McGrogan, P. and Russell, R.K. and Ahmed, S.F (2012) Growth in children receiving contemporary disease specific therapy for Crohn's disease. Archives of Disease in Childhood, 97 (8). pp. 698-703. ISSN 0003-9888

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Abstract

It is unclear whether recent therapeutic advances have improved the growth of children with Crohn's disease (CD). To assess the frequency of short stature and poor growth and their relationship to disease course and therapy in children with CD. 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. 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. 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. 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). 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