Growth retardation in inflammatory bowel disease
Kirschner, B.S.; Voinchet, O.; Rosenberg, I.H.
Gastroenterology 75(3): 504-511
1978
ISSN/ISBN: 0016-5085 PMID: 680509 Document Number: 137359
Growth retardation and delay in sexual maturation complicate child-onset Crohn's disease in nearly 1 in 5 patients, with a somewhat lower complication rate in ulcerative colitis. Successful management of this complication requires an understanding of the appropriate definition of growth retardation in inflammatory bowel disease, and a critical assessment of its etiology and responses to therapy. To date, no specific endocrin abnormalities can be implicated in the pathogenesis of growth retardation in inflammatory bowel disease. However, studies of end organ responsiveness to hormones in such patients are still rudimentary. A factor of considerable etiological prominence is that of calorie insufficiency superimposed on protein, vitamin, and mineral deficiencies. Therapy for growth retardation is usually successful when control of the disease is effective. When either medical or surgical therapy controls disease and permits oral nutritional restitution and adequate calorie and pretien intake, growth and maturation are frequently reestablished. Usually, such nutritional restitution requires the use of oral formula supplements. Less commonly, adjunctive peripheral i.v. therapy with amino acids and lipid emulsions is required to initiate nutritional repletion. Rarely, total parenteral alimentation is indicated in patients in whom complete bowel rest is required. Surgery is indicated for complications such as obstruction, perforation, and fistula and should be considered for those whose growth retardation fails to respond to a maximal medical/nutritional program.