UPDATE 1-Young IBD patients gain height after expected growth-plate closure

Last Updated: 2020-02-19

(Updates Feb 11 story with comments from researcher, in three new paragraphs at the end of the story)

By Reuters Staff

NEW YORK (Reuters Health) - Young people with Crohn's disease (CD) or ulcerative colitis (UC) often continue to grow in height beyond the typical time of growth-plate closure, according to new findings.

"Height curves and height velocity curves generated by this study support delayed skeletal maturation and capacity for catch-up growth in IBD," Dr. Neera Gupta of Weill Cornell Medicine in New York City and colleagues write in Inflammatory Bowel Diseases.

Growth impairment often occurs in pediatric CD, and less frequently in UC, Dr. Gupta and her team note. Radiographic closure of the growth plates, which marks the end of statural growth, typically occurs in females at around age 15 and in males around 17.

The authors investigated statural growth beyond expected skeletal maturation in more than 3,000 IBD patients, about three-quarters of whom had CD. All had their height measured at at least three visits at least six months apart.

Overall, 80% had continued growth, and this occurred significantly more often in CD (81% of patients) than UC (75%) and in female CD patients (83%) than males (79%).

Median growth was 1.6 centimeters in CD males, 1.3 cm in UC males, 1.8 cm in CD females and 1.5 cm in UC females.

Compared with children in the National Health and Nutrition Examination Survey, height velocity curves were shifted to the right in the IBD patients.

The findings suggest that delayed skeletal maturation may be more common than previously thought in UC patients, Dr. Gupta and her colleagues write.

Parents of children with IBD often ask if they might grow taller than expected due to delayed bone age, the authors note. "Theoretically, if a child has delayed skeletal maturation but then achieves IBD remission (inflammation is well-controlled) and an optimal height velocity, the child may indeed end up taller than she/he would have without the disease," they write.

"Bone age history and current status and statural growth history and current status should be a standard part of communication from pediatric gastroenterologists to adult gastroenterologists when a patient is transitioning care," they conclude.

Dr. Gupta told Reuters Health by email that in the multicenter longitudinal Growth Study (#GrowthStudy), underway now, her team is "using the male-female dichotomy in risk for growth impairment . . . as a window for understanding the effects of inflammation on growth in both sexes."

"We will identify factors that classify a patient as high risk for developing growth impairment refractory to standard approaches to therapy," she said. "These patients may benefit from early introduction of aggressive medical therapies."

The research published in Inflammatory Bowel Diseases was sponsored by ImproveCareNow, with support from Celgene Corporation. Dr. Gupta said "the robust database in the ImproveCareNow registry" made the study possible. "At the time of this report," she said, "there were over 100 care centers in (the United States), England, Qatar and Belgium, encompassing over 900 pediatric gastroenterologists caring for over 30,000 children, including an estimated half of pediatric patients with IBD cared for by pediatric gastroenterologists in the United States."

SOURCE: https://bit.ly/2tHdrOm Inflammatory Bowel Diseases, online January 22, 2020.