CLINICAL COURSE AND GROWTH OF CHILDREN WITH CROHN'S DISEASE

P Kundhal, J Critch, C Hack, A Griffiths

Division of Gastroenterology/Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario

BACKGROUND/AIM: Previous studies have documented the prevalence of growth impairment in pediatric Crohn’s disease as treated during the 1980’s, but no more recent data exist. We reviewed the growth patterns and clinical course of children with Crohn’s disease during the most recent decade, in order to capture the spectrum of outcomes prior to the new era of available biologic therapies.

METHODS: The records of Tanner stages I-II children diagnosed and followed with Crohn’s disease at the Hospital for Sick Children, Toronto from 1990-1999 for a minimum of two years were reviewed. Standard deviation scores (SDS) for height were calculated using population-based data from the Center for Disease Control (released in May 2000). The influence of gender, anatomic location of disease and symptom severity on linear growth was analyzed by univariate and multivariate regression analysis. All values are given as mean +/- SD.

RESULTS: 163 (106 male) consecutively diagnosed children aged 10.9 +/-2.1 years in pre- or early puberty were followed for 4.7 +/- 1.7 years (range 2.0–10.0 years). The SDS for height at diagnosis was -0.76 +/- 1.25 (males: -0.71 +/- 1.20, females: -0.84 +/- 1.33). The mean height velocity (cm/year) during year one and two were 4.7 +/- 2.6 and 5.6 +/- 3.0 respectively; however, 45% of children during year one and 33% during year two experienced impaired growth velocity (height velocity <4 cm/year). Severity of symptoms was the major factor influencing linear growth velocity during both years one and two (p<0.0001). Anatomic localization was not an independent risk factor for growth impairment. Among a subset of 37 children (18 male) followed to maturity the final SDS for height was -0.13 +/- 1.02. Compared to diagnosis, change in SDS was 0.10 +/- 0.94. Females were noted to have greater improvement in growth than males (change in SDS = 0.47 +/- 0.68 versus -0.29 +/- 1.02; p=0.011).

CONCLUSIONS: Growth impairment continues to be a frequent complication of intestinal inflammation in pediatric Crohn’s disease. As in an earlier decade, males are particularly vulnerable to compromise of growth during puberty relative to their healthy peers.

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