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Steroid Administration and Growth Impairment in Children with Crohn's Disease

Duchatellier, Carl Frédéric MD, MSc*,†; Kumar, Rituanjali MSc*; Krupoves, Alfreda MD, PhD*; Braegger, Christian MD; Herzog, Denise MD; Amre, Devendra K. MBBS, PhD*,§

doi: 10.1097/MIB.0000000000000669
Original Clinical Articles

Background: Growth impairment remains a major concern in children with Crohn's disease, but evidence remains unclear, in particular, whether steroid use is implicated. We aimed to (1) determine the frequency of temporary (TGI) and permanent (PGI) growth impairment in children administered steroids and (2) examine whether cumulative steroid administration was associated with TGI and/or PGI.

Methods: A retrospective cohort study was performed in patients with Crohn's disease (<18 yr) administered steroids at the gastroenterology clinics of Sainte-Justine Hospital, Montreal. Steroid dosage, height during follow-up, adult height (after age 20), and parental heights were ascertained. Patients with height z score <−1.64 on more than 1 occasion before age 18 were considered as patients with TGI. Patients with adult heights <8.5 cm below the expected target heights were considered as patients with PGI. Association between steroid dosage and TGI/PGI was studied using logistic regression analyses. Data from the Swiss IBD Cohort Study were analyzed for comparison.

Results: A total of 221 children were studied. Approximately 19% (42/221) children were deemed as TGI, and 8/137 patients (5.8%) had PGI. TGI was associated with diagnosis at younger age (P value 0.002) and steroid administration at younger age (P value 0.001), but not with steroid dosage. Final adult height was associated with target height, but not with cumulative steroid dosage. Rates of PGI in the Swiss cohort were ∼9.1% in steroid users and 2.7% in nonusers.

Conclusions: Most children with TGI attain normal adult heights. Cumulative steroid use does not seem to be associated with either TGI or PGI in children with Crohn's disease.

Article first published online 11 January 2016.

*Centre de Recherche CHU Sainte-Justine, Montréal, QC, Canada;

Department of Biomedical Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada;

Division of Gastroenterology and Nutrition, University Children's Hospital Zurich, Zurich, Switzerland; and

§Department of Pediatrics, University of Montréal, Montréal, QC, Canada.

Reprints: Devendra K. Amre, MBBS, PhD, Centre de Recherche, Bureau 3734, CHU Ste-Justine, 3175 Cote-Sainte-Catherine, Montréal, QC H3T 1C5, Canada (e-mail:

Supported by the Canadian Institutes of Health Research (CIHR), Canada. The Swiss IBD Cohort Study was supported by a research grant from the Swiss National Science Foundation (Grant No. 3CSC0_13,427).

The authors have no conflict of interest to disclose.

Received August 22, 2015

Accepted October 14, 2015

© Crohn's & Colitis Foundation of America, Inc.
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