Growth in Paediatric Crohn’s Disease

Abstract

Growth failure (GF) is one of the major complications affecting children with inflammatory bowel disease. The faltering is temporary in 40–50% of cases and prolonged in 10–20% in Crohn’s disease (CD). Such failure is rare in children with ulcerative colitis (5%). This complication is often associated with retarded bone development and delayed onset of sexual maturation. The delayed linear growth has a variety of causes including insufficient intake due to anorexia and the inflammatory process with increased energy and protein expenditure. Other factors are increased intestinal loss, secondary hypopituitarism and treatment with steroids. Therapeutic strategies of CD in children have changed this last decade by introducing new therapeutic agents such as topic steroids, immunosuppressors, anti-TNF (antibody and notably in children enteral nutrition which has shown its efficacy in inducing remissions of active CD, restoring nutritional status and stimulation of linear growth. The results of a recent prospective multicentric study over 2 years in 82 CD show that severe GF (–2 SD) is initially present in 15% (n = 12), among them 11 remain < –2SD after 2 years of follow-up. Six patients who were on the normal range initially increased their GF during the follow-up (< –2SD) (total 21% < –2SD (n = 17) at 2 years). At inclusion in this group there was no difference in growth velocity, used of steroids, enteral nutrition or severity of CD as compared to the group with no GF. It suggests that new treatment strategy should be developed in the future for this specific complication of paediatric CD.

Levodopa-Induced Dyskinesias in Parkinson’s Disease: Etiology, Impact on Quality of Life, and Treatments

“…Increasing severity of dyskinesias is also associated with increasing depression [47]. Other studies have shown that dyskinesias can seriously interfere with the performance of activities of daily living [50], ambulation, and balance [51], and that they can be associated with increased falls [52] and unintended weight loss [53]. On the other hand, other investigators have reported that dyskinesias do not have a significant impact on QoL [16, 35, 54] and may not pose a major concern for patients [14, 55, 56].…”

Tratamento com hormônio de crescimento em crianças com doenças crônicas

“…observaram que 30% a 40% dos pacientes com doença de Crohn até 18 anos de idade apresentavam peso e estatura abaixo do esperado, idade óssea atrasada e atraso da maturação sexual. O déficit de estatura foi observado em 40% dos pacientes antes do início dos sintomas específicos da doença intestinal e em 60% no momento do diagnóstico (40). Em um grupo de 123 pacientes com doença de Crohn atendidos em centro especializado e recebendo nutrição enteral, Sawczenko e cols.…”

Improving Growth in Children with Inflammatory Bowel Disease

“…Stimulated GH levels may be low in some children and some may have low serum IGF-I but normal levels of stimulated or physiological GH secretion [42,43,44,45]. The link between systemic GH levels either from stimulation tests or physiological sampling, as well as serum IGF-I levels and linear growth in IBD, is still unclear, although one group has reported an association between systemic IGF-I level and height velocity in children with IBD [46]. Short stature and growth retardation seem to be particularly pronounced in peripubertal children, and delayed puberty has been commonly reported in these children [1].…”