Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, Stollery Children's Hospital, Room 4-577, 11405 87th Avenue NW, Edmonton, AB, T6G 1C9, Canada.
Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Edmonton Pediatric IBD Clinic (EPIC), Edmonton Clinic Health Academy, University of Alberta, Stollery Children's Hospital, Room 4-577, 11405 87th Avenue NW, Edmonton, AB, T6G 1C9, Canada.
Dig Dis Sci. 2021 Apr;66(4):954-964. doi: 10.1007/s10620-020-06759-5. Epub 2021 Jan 12.
Growth delay with height and weight impairment is a common feature of pediatric inflammatory bowel diseases (PIBD). Up to 2/3 of Crohn Disease patients have impaired weight at diagnosis, and up to 1/3 have impaired height. Ulcerative colitis usually manifests earlier with less impaired growth, though patients can be affected. Ultimately, growth delay, if not corrected, can reduce final adult height. Weight loss, reduced bone mass, and pubertal delay are also concerns associated with growth delay in newly diagnosed PIBD patients. The mechanisms for growth delay in IBD are multifactorial and include reduced nutrient intake, poor absorption, increased fecal losses, as well as direct effects from inflammation and treatment modalities. Management of growth delay requires optimal disease control. Exclusive enteral nutrition (EEN), biologic therapy, and corticosteroids are the primary induction strategies used in PIBD, and both EEN and biologics positively impact growth and bone development. Beyond adequate disease control, growth delay and pubertal delay require a multidisciplinary approach, dependent on diligent monitoring and identification, nutritional rehabilitation, and involvement of endocrinology and psychiatry services as needed. Pitfalls that clinicians may encounter when managing growth delay include refeeding syndrome, obesity (even in the setting of malnutrition), and restrictive diets. Although treatment of PIBD has improved substantially in the last several decades with the era of biologic therapies and EEN, there is still much to be learned about growth delay in PIBD in order to improve outcomes.
生长迟缓伴有身高和体重受损是小儿炎症性肠病（PIBD）的常见特征。多达 2/3 的克罗恩病患者在诊断时体重受损，多达 1/3 的患者身高受损。溃疡性结肠炎通常发病较早，生长迟缓程度较轻，但患者仍可能受到影响。最终，如果不加以纠正，生长迟缓会降低成年终身高。体重减轻、骨量减少和青春期延迟也是新诊断的 PIBD 患者生长迟缓相关的问题。IBD 患者生长迟缓的机制是多因素的，包括营养摄入减少、吸收不良、粪便丢失增加，以及炎症和治疗方式的直接影响。生长迟缓的管理需要实现疾病的最佳控制。肠内营养（EEN）、生物治疗和皮质类固醇是 PIBD 中主要的诱导策略，EEN 和生物制剂都对生长和骨骼发育有积极影响。除了充分控制疾病外，生长迟缓及青春期延迟需要多学科方法，取决于对患者的密切监测和识别、营养康复以及根据需要转至内分泌科和精神科。临床医生在管理生长迟缓时可能遇到的陷阱包括再喂养综合征、肥胖（即使在营养不良的情况下）和限制饮食。尽管过去几十年中，生物治疗和 EEN 的时代使 PIBD 的治疗得到了极大改善，但仍有许多关于 PIBD 中生长迟缓的问题需要研究，以改善其结局。
