P215. Growth pattern and growth failure in paediatric Crohn's disease are related to inflammatory status but not to duration of steroid therapy
D. Ley1, H. Béhal2, C. Gower-Rousseau3,4, A. Duhamel2, M. Fumery5, F. Vasseur4, L. Michaud1, I. Rousseau4, G. Savoye6, D. Turck1, 1University and Hospital, Paediatric, Lille, France, 2University and Hospital, Biostatistics EA 2694, Lille, France, 3Health, Epidemiology, Lille, France, 4University and Hospital, Epidemiology, Lille, France, 5University and Hospital, Gastroenterology, Amiens, France, 6University and Hospital, Gastroenterology, Rouen, France
Growth failure is the main complication of paediatric-onset Crohn's disease (CD). The respective role of disease activity and steroid therapy in growth faltering is still a matter of debate. The aim of the present study was to investigate whether the growth pattern of children with CD was correlated with the evolution of inflammatory status during the disease course, whatever the cumulative duration of steroid therapy.
107 patients (63 boys and 44 girls) with a diagnosis of CD made at less than 17 years of age, followed in the same unit during more than years and for whom more than 2 height measures were available during follow-up, were identified between 1998 and 2012. Height, C-reactive protein (CRP), orosomucoid and information on steroid therapy (including date of prescription and daily dose) were collected at each visit. Growth velocity was compared to the evolution of inflammatory status during follow-up in a longitudinal multivariate analysis using a mixed model.
Median age at CD diagnosis was 11.7 years (Q1-Q3: 9.8–13.5). Growth failure (Height/Age Z-score <−2) was present in seven patients (8%) at diagnosis and in five (5%) at maximal follow-up (median: 4.9 years; Q1-Q3: 3.8–6.4). Among the 75 patients who had achieved their growth at maximal follow up, mean Height/Age Z-score was 0.1±1.2. Twenty patients (29%) reached their final height that was at least 4 cm below their target height. A total of 2112 height measures were available. Growth velocity was not influenced by the cumulative duration of steroid therapy (median: 7.1 months; Q1-Q3: 4.9–12.5), but was negatively correlated with the evolution of CRP (coefficient of the equation of regression (e) = −0.16; p < 0.0001) and orosomucoid (e = −0.60; p < 0.0001) during follow-up.
CD children with uncontrolled inflammatory status have a lower growth velocity and a higher risk for growth failure, regardless of cumulative duration of steroid therapy. The inflammatory status should be kept normal as much as possible in paediatric-onset CD patients in order to optimize their growth pattern.