P0678 FINAL ADULT HEIGHT OF CHILDHOOD ONSET CROHN???S DISEASE: MEAN HEIGHT DEFICIT IS 3???4CM, BUT 25% DO NOT REACH THEIR GENETICALLY DETERMINED HEIGHT RANGE

Abstract

Introduction: Growth failure is an important feature of paediatric onset Crohn’s disease (CD) but there are few data regarding final adult height, in particular height deficit has rarely been described with respect to mid-parental height. The aim of this study was to determine final adult height and to examine the factors that might influence growth. Methods: We retrospectively identified 77 cases diagnosed before age 16 yrs who had achieved final adult height [defined as height > 22 yrs, or documented growth velocity <1cm/year] and in whom parental heights (Hts) were also known. No case had any other growth-inhibiting conditions. Hts were converted into standard deviation scores (SDS). Univariate analysis was undertaken of factors postulated to affect Ht: length of delay from onset of symptoms to diagnosis, pre/post pubertal onset of symptoms, site of disease activity, sex, systemic steroid therapy, and mid-parental Ht SDS. Positive factors were entered into regression models. Results: M 53%, F 47%. Median age at diagnosis 12.0 yrs after a median 1.0 yr delay. 29% had jejunal involvement. 74% had 1 or more courses of systemic steroids during follow up. Mean paternal and maternal heights were both 0.0 SDS. Mean Ht SDS of the cases were −0.7 at diagnosis improving to −0.4 at final adult height [p = 0.024]. Although the mean deficit at final adult height was 3.4cm from mid-parental height [95% CI -1.8 to -5.0cm], this included 25% with a deficit of >8cm [that is less that genetic potential]. In the regression models Ht SDS at diagnosis was negatively correlated with length of delay and positively correlated with parental SDS [R2 0.55]. Final adult height SDS was also related to parental height SDS, but the most important factors were presence of jejunal disease and height SDS at diagnosis [R2 0.64]. All these factors remained significant if length of delay was added to the model. Conclusion: This is largest group of children followed up to final adult height. The presenting features of this group, such as age, sex, height SDS and percentage with jejunal involvement are very similar to those currently reported across the British Isles [1]. The mean adult height deficit was 3–4cm, but this figure hides the 25% of cases who did not attain an adult height within the genetic range, as determined by their mid-parental height. Delay in diagnosis was related both to loss of height at diagnosis and to impaired potential for ‘catch up’. Jejunal disease predisposed to growth impairment following diagnosis. Both earlier diagnosis and improved management of cases with jejunal disease might lead to improved final adult height.