Growth failure, a common complication of childhood Crohn’s disease, is more common in men than women, but the reasons are unclear. Now, a physician-scientist from Weill Cornell Medicine and NewYork-Presbyterian and colleagues at eight other centers have found that factors associated with physique growth vary by gender. Their recent publication, referred to as the “Editor’s Choice/Leading Off” article and a mention on the cover of the June issue of Inflammatory Bowel Diseases, underscores the need to research and develop gender-specific treatment strategies for children with Crohn’s disease. approach that is not currently part of the algorithm for treating Crohn’s disease in children.
The Growth Study is an ongoing prospective, multicenter, longitudinal cohort study investigating sex differences in growth failure in children with Crohn’s disease. For their current analysis, lead author Dr. Neera Gupta, principal investigator of The Growth Study, director of research for the Pediatric Inflammatory Bowel Disease (PIBD) Program, and an associate professor of pediatrics at Weill Cornell Medicine and a pediatric gastroenterologist at NewYork-Presbyterian Komansky Children’s Hospital and colleagues examined a series of variables that linked account of physique growth by sex for 113 children with Crohn’s disease, such as disease characteristics, patient-reported symptoms at initiation, and use of certain medications.
In 41 female patients, an initial classification of IBD as Crohn’s disease or perianal disease at diagnosis was associated with better growth. However, patient-reported joint pain at symptom onset or the use of probiotics or azathioprine/6-mercaptopurine was associated with poorer growth.
Variables associated with stature growth were markedly different for 72 male patients. Patient-reported poor growth at symptom onset or use of infliximab, biologics, methotrexate, or vitamin D were associated with better growth. In contrast, initial classification of IBD as Crohn’s disease or patient-reported anorexia or mouth ulcers at symptom onset was associated with poorer growth.
The authors noted that female patients appear to grow better independent of disease severity/inflammatory burden and drug interventions. Their findings suggest that sex-specific molecular pathways lead to stunted 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 medications used to treat Crohn’s disease in children. Gender is likely to be an important future determinant of treatment decisions, marking significant advances in clinical decision making for childhood Crohn’s disease.
“With the growth study, we aim to transform care for pediatric patients with Crohn’s disease by providing an evidence-based approach for the appropriate early introduction of aggressive therapy in high-risk patients of any gender, as there is only a narrow therapeutic window.” available for intervention to improve body growth,” the authors wrote.
For more information about the #GrowthStudy, follow @NeeeraGuptaMD on Twitter & Instagram.
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