Serum concentrations of tumour necrosis factor in childhood chronic inflammatory bowel disease

Accepted for publication 10 September 1990 Abstract Serum tumour necrosis factor a (TNFa) concentrations were measured by enzyme linked immunoadsorbent assay in 31 normal children and during 65 episodes of clinical remission and 54 episodes of relapse in 92 children with chronic inflammatory bowel disease. An appreciable rise in TNFa was found only in children in relapse of ulcerative colitis and colonic Crohn's disease. The group ofchildren with small bowel Crohn's disease in relapse did not show increases of TNFa above control concentrations, despite an equivalent rise in disease indices. Height velocity was depressed in children with relapse of large bowel Crohn's disease and ulcerative colitis compared with the equivalent condition in remission. The impairment of growth velocity was significandy greater in relapse of large bowel Crohn's disease and ulcerative colitis than in small bowel Crohn's disease alone, although for the subgroups in stage 1 puberty (prepubertal) the differences were not significant. Inadequate growth in chronic inflammatory bowel disease is currently ascribed to inadequate nutrition and TNFa may contribute to this through its cachexia inducing effects. It may, in addition, diminish pituitary growth hormone release. These results suggest that production of TNFa may be associated with growth failure in relapse of colonic inflammatory bowel disease.