Growth failure and intestinal inflammation

At least one third of patients with inflammatory bowel disease (IBD), namely Crohn's disease and ulcerative disease (UC), first develop symptoms during childhood and adolescence. In contrast to the adult population, in which the incidence of Crohn's disease has plateaued, the incidence of juvenile‐onset Crohn's disease continues to increase.1 The clinical spectrum and severity of disease varies considerably in young people, as it does in adults, but there are a number of special problems that face children and adolescents with IBD. In this review we will discuss the prevalence, aetiology, pathogenesis and management of growth failure in these patients. Growth failure frequently complicates the clinical course of children with IBD, more often in Crohn's disease than in UC.2,,3 Its reported frequency depends to some extent on its definition; a reduction in height velocity is the most accurate measurement of growth. A decrease in height velocity below the third centile has been reported in as many as 88% of patients before the diagnosis of Crohn's disease; in just over half of this group, growth failure was documented before the onset of symptoms attributable to Crohn's disease.4 During the subsequent clinical course, 20–40% of patients continue to have severe linear growth retardation, defined as height below the third centile.3,5,,6 While the majority of adults who had onset of IBD in childhood have heights between the 5th and the 97th centile, the distribution is skewed towards the lower centiles (Table 1).7 Final height below the fifth centile is reported in 7–30% of patients.7–,10 View this table: Table 1 Distribution of adult height percentiles in patients with early onset IBD7 Growth failure associated with IBD has been attributed chiefly to undernutrition.11–,13 The nutritional deficiency appears to be related primarily to inadequate calorie intake, …