Growth and development of children with inflammatory bowel disease

Kronična upalna bolest crijeva (engl. IBD – inflammatory bowel disease) je autoimuna sistemska bolest, koja, uz interakciju genetike i okoliša, uzrokuje upalu uglavnom lokaliziranu u sluznici probavnog trakta. U ovoj skupini razlikujemo tri bolesti – ulcerozni kolitis, Crohnovu bolest i nerazvrstani kolitis. U 20 – 25% slučajeva simptomi tih dviju bolesti počinju u ranom djetinjstvu ili adolescenciji. Osim gastrointestinalnih simptoma (kao što su dijarea i bolovi u trbuhu), za pedijatrijsku dob su karakteristične ekstraintestinalne manifestacije bolesti vezane za pojavu bolesti prije pubertetskog zamaha rasta. Tako loša regulacija bolesti uz slabije cijeljenje sluznice i povećane koncentracije proinflamatornih citokina, malnutricija, povećane potrebe za energijom i kortikosteroidi u terapiji dovode do deficita brojnih tvari u organizmu, zastoja u rastu, zakašnjelog puberteta, te smanjene gustoće kostiju. Zastoj u rastu je zabilježen u do 40% pacijenata s Crohnovom bolešću i u manje od 10% pacijenata s ulceroznim kolitisom. Gubitak tjelesne mase je prije dijagnoze bolesti zabilježen u 80% pacijenata s Crohnovom bolešću i 60% s ulceroznim kolitisom. Za evaluaciju ovih promjena koristimo centilne krivulje visine i mase za dob, Z-vrijednosti visine i mase za dob, BMI kao mjeru uhranjenosti, te određujemo stupanj pubertetskog razvoja prema Tanneru. Glavni ciljevi terapije su poboljšati rast i razvoj smanjujući upalu sa što dužim razdobljima remisije uz poštedu od terapije kortikosteroidima, te održati adekvatnu uhranjenost, kako bismo postigli očekivanu konačnu visinu, povećali kvalitetu života pacijenta, uz održan normalan fizički, spolni, intelektualni i psihosocijalni razvoj.Inflammatory bowel disease (IBD) is an autoimmune system disease, with interaction of genetics and environment, causing an inflammation, mainly located in mucosa of the small intestine and bowel. We distinguish three diseases in this group – Crohn's disease (CD), ulcerative colitis (UC) and indeterminate colitis. The onset period of 20 – 25% of all the cases of IBD is childhood and adolescence. Along with intestinal symptoms (diarrhea and abdominal pain), there are extraintestinal manifestations of the disease, specific for pediatric patients, because of the onset of symptoms before pubertal growth spurt. Those are delay in growth and puberty, lack of many nutrients and decreased bone mineral density due to poor disease control (with poor mucosa healing and high concentrations of proinflammatory cytokines), malnutrition, increased energy needs and corticosteroid therapy. Growth failure has been reported in up to 40% of the children with Crohn's disease and less than 10% of the children with ulcerative colitis. Body weight loss was recorded in 80% of the patients with Crohn's disease and 60% with ulcerative colitis before the diagnosis. In order to evaluate these manifestations we use height and weight percentile curves for age, calculate height and weight for age Z-score, BMI, as a measure of nutritional status, and evaluate Tanner stage to determine pubertal development. The main therapy goals are to improve growth and development induced with decreased inflammation, improved nutrition with longer remission periods induced without corticosteroids resulting in the achievement of expected adult height, improvement of patient's quality of life, and maintenance of the adequate physical, sexual, intellectual and psychosocial development