For pediatric patients with Crohn’s disease, the factors associated with the growth of the structure differ according to sex.


High-magnification micrograph of Crohn’s disease. Esophageal biopsy. Taca H&E. Credit: Nephron / Wikipedia

Growth impairment, a common complication of Crohn’s disease in children, occurs more often in men than in women, but the reasons are unclear. Now, a Weill Cornell Medicine and NewYork-Presbyterian physician-scientist and colleagues from eight other centers have found that the factors associated with structure growth differ by gender. Its recent publication, identified as the article “Editor’s Choice / Leader” and which receives a mention on the cover of the June issue of Inflammatory bowel diseases, emphasizes the need to research and develop sex-specific treatment strategies for children with Crohn’s disease, an approach that is not currently part of the pediatric Crohn’s disease management algorithm.

The study of growth is a longitudinal, prospective, multicenter cohort study that investigates sexual differences in growth impairment in children with Crohn’s disease . For her current analysis, the lead author, Dra. Neera Gupta, principal investigator of The Growth Study, research director of the Pediatric Inflammatory Bowel Disease (PIBD) program and associate professor of pediatrics at Weill Cornell Medicine and pediatric gastroenterologist at NewYork-Presbyterian Komansky Children’s Hospital and colleagues leagues examined a number of variables associated with the stature growth by sex of 113 children with Crohn’s disease, such as disease characteristics, patient onset symptoms, and use of certain medications.

Between 41 , an initial classification of IBD as Crohn’s disease or perianal disease at diagnosis was associated with better growth. However, joint pain reported by the patient at the onset of symptoms or the use of probiotics or azathioprine / 6-mercaptopurine were associated with worse growth.

The variables associated with structure growth were markedly different for 72 . Poor growth reported by the patient at the onset of symptoms or the use of infliximab, biological products, methotrexate, or vitamin D were associated with better growth. In contrast, an initial classification of IBD as Crohn’s disease or anorexia or mouth ulcers reported by the patient at the onset of symptoms was associated with worse growth.

The authors noted that female patients appear to grow better regardless of the severity of the disease / inflammatory load and medication interventions. Their findings suggest that sex-specific molecular pathways lead to impaired growth in children with Crohn’s disease and that there may be a difference in the response of these sex-specific molecular pathways to current drugs used to treat pediatric Crohn’s disease. Gender is likely to be an important future determinant of treatment decisions, which will represent a major breakthrough in clinical decision making for pediatric Crohn’s disease.

“By studying growth, we aim to transform care for pediatric patients with Crohn’s disease by providing an evidence-based approach to the correct early introduction of aggressive therapy in patients at high risk for each sex because there is only a narrow therapeutic window available for intervention to enhance structural growth, ”the authors wrote.

Early use of biological products is recommended in patients with moderate to severe Crohn’s disease

More information:
Neera Gupta et al, Clinical variables associated with structural growth in pediatric Crohn’s disease, by sex (growth study), Inflammatory bowel diseases (2020). DOI: 10.1093 / ibd / izaa220

Citation: For pediatric patients with Crohn’s disease, factors associated with stature growth differ by sex (2021, July 10) retrieved July 10, 2021 at -patients-crohn-disease-factors .html

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