GROWTH FAILURE IN PEDIATRIC INFLAMMATORY BOWEL-DISEASE

To assess whether children with inflammatory bowel disease (IBD) devel op permanent impairment of linear growth, we analyzed records from 48 young adults who had IBD during childhood or early adolescence (Tanner I-III; 11.8 +/- 2.4 years old at diagnosis). All were fully grown (Ta nner V; 21.1 +/- 3.0 years) at last examination. Adult heights were pr edicted from data obtained at or shortly after the diagnosis of IBD by three methods: height for age percentile, the Bailey-Pinneau (BP), an d Roche-Wainer-Thissen (RWT) methods. Predicted adult heights were the n compared with the actual ultimate height of each subject. Permanent growth failure occurred in 19-35% of subjects, depending upon the meth od used to assess growth. Overall, 31% (15 of 48) of the subjects had deficits of adult height identified by two or more methods, including 14 of 38 (37%) of those with Crohn's disease but only one of 10 with u lcerative colitis. Age at diagnosis of IBD, age at last examination, a ge at cessation of linear growth, and site of IBD did not differ betwe en impaired and normal growth groups. Duration of corticosteroid use w as longer (p < 0.05) in growth-impaired subjects. In addition, althoug h 60% of all subjects had periods of poor growth that put them in heig ht-for-age percentiles two or more major growth channels below previou s percentiles, only 19% remained at these levels upon achieving their final adult heights. Permanent impairment of linear growth leading to clinically meaningful deficits of ultimate adult height is common in p atients with IBD in childhood or early adolescence. New therapeutic ap proaches are needed to address this problem.