Journal Article•
Severe growth retardation in children with inflammatory bowel disease
TL;DR: Endocrine evaluation demonstrated abnormally low 24-hour urinary gonadotropins in five of six patients more than age 16, and depressed growth hormone response to insulininduced hypoglycemia in 11 of 13 tested.
Abstract: From a group of 130 youngsters with inflammatory bowel disease, 22 were severely growth retarded (below the third percentile in height). This had preceded gastrointestinal symptoms for 1 to 11.4 years in 8 patients and corticosteroid therapy in 14. Endocrine evaluation demonstrated abnormally low 24-hour urinary gonadotropins in five of six patients more than age 16, and depressed growth hormone response to insulininduced hypoglycemia in 11 of 13 tested. Growth retardation in this group was attributed to a secondary hypopituitarism.
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TL;DR: Production of TNF alpha may be associated with growth failure in relapse of colonic inflammatory bowel disease and it may diminish pituitary growth hormone release.
Abstract: Serum tumour necrosis factor alpha (TNF alpha) concentrations were measured by enzyme linked immunoadsorbent assay in 31 normal children and during 65 episodes of clinical remission and 54 episodes of relapse in 92 children with chronic inflammatory bowel disease. An appreciable rise in TNF alpha was found only in children in relapse of ulcerative colitis and colonic Crohn's disease. The group of children with small bowel Crohn's disease in relapse did not show increases of TNF alpha above control concentrations, despite an equivalent rise in disease indices. Height velocity was depressed in children with relapse of large bowel Crohn's disease and ulcerative colitis compared with the equivalent condition in remission. The impairment of growth velocity was significantly greater in relapse of large bowel Crohn's disease and ulcerative colitis than in small bowel Crohn's disease alone, although for the subgroups in stage 1 puberty (prepubertal) the differences were not significant. Inadequate growth in chronic inflammatory bowel disease is currently ascribed to inadequate nutrition and TNF alpha may contribute to this through its cachexia inducing effects. It may, in addition, diminish pituitary growth hormone release. These results suggest that production of TNF alpha may be associated with growth failure in relapse of colonic inflammatory bowel disease.
474 citations
TL;DR: In a unique group of children, growth failure is an early, "prepatterned" manifestation of IBD, and the inflammatory process, rather than steroid use, has a predominant influence on the development of growth faltering.
289 citations
287 citations
TL;DR: It is demonstrated that chronic intermittent elemental diet effectively reverses growth arrest, while decreasing prednisone requirements and Crohn's disease activity index in pediatric Crohn't disease patients prior to puberty.
233 citations
212 citations