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Hormonal therapy for impaired growth due to pediatric-onset inflammatory bowel disease: a systematic review and meta-analysis with trial sequential analysis

  • Mardhen Catunda Rocha Melo ORCID logo EMAIL logo , Rian Vilar Lima , Maryana Modena Strada , João Lucas Maia Rocha , Beatriz Vieira Cavalcante , Maria Lya Pinheiro Bezerra , Lívia Vasconcelos Martins , Maria Clara Parente Torquato , Túlio Veras Veloso and Delanie Bulcao Macedo
Published/Copyright: April 8, 2025
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 6

Abstract

Introduction

Inflammatory bowel diseases (IBDs) have an increasing incidence in the pediatric population. The dysabsorptive effects of this condition often lead to a decrease in linear growth. However, the effectiveness and safety of growth hormone (GH) therapy in this population is still a topic of debate, with studies showing conflicting results.

Content

MEDLINE, Embase, and Cochrane Library databases were systematically searched according to the PRISMA guidelines. All experimental studies featuring children with IBD receiving GH therapy were included. In addition, a trial sequential analysis (TSA) was conducted to determine the sample size required for each outcome. The prospective registry was carried out under protocol CRD42024563079. The total data set comprised eight studies involving 127 patients with IBD, 78 (61.41 %) of whom received GH therapy, with a mean follow-up duration of 1.3 years. A statistically significant effect of GH was found in increasing the height standard deviation score (HtSDS) of children with IBD (standardized mean difference – SMD=1.07; CI=0.58, 1.56; p<0.0001). When comparing children who received GH with controls, no significant improvement in HtSDS was observed (SMD=0.18; CI=−0.73, 1.08; p=0.70). However, meta-regression analysis indicated that a longer follow-up was associated with a greater improvement in the HtSDS (p=0.04). Regarding height velocity (HV), a significant increase was found when comparing measurements before and after the initiation of hormone therapy (mean difference – MD=4.09; CI=2.58, 5.60; p<0.0001). An increase in HV was also noted in children receiving GH compared to the control group (MD=4.47; CI=2.03, 6.90; p=0.0003). No significant changes in the Pediatric Crohn’s Disease Activity Index (PCDAI) were detected, comparing values before and after the start of treatment (MD=−10.09; CI=−22.29, 2.10; p=0.10). The overall prevalence of any adverse effect was estimated at 15.51 % (95 % CI: 2.32–58.70 %). Most common reaction was itching at injection sites. TSA indicated a low risk of overestimating or underestimating the intervention’s effect on the analyzed outcomes.

Summary

Our study points to the effectiveness and safety of GH therapy in children with IBD and growth impairment.

Outlook

Further randomized controlled trials (RCT) with standardized methodologies and extended follow-up periods are necessary to confirm these findings.

Keywords: growth hormone; inflammatory bowel disease; growth failure
Corresponding author: Mardhen Catunda Rocha Melo, Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 – Edson Queiroz, Fortaleza, 60811-905, Ceará, Brazil, E-mail:

Acknowledgments

We would like to thank Antônio Brazil Viana Júnior for his valuable contribution in reviewing the statistical analysis.

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: M.C.R.M: wrote the final version of the manuscript; edited figure 1; R.V.L: wrote the abstract and the first version of the manuscript edited figures 2, 3, and 4; M.M.S: participated in the process of screening articles, extracting data, and assessing the risk of bias; J.L.M.R: participated in the process of screening articles, extracting data, and assessing the risk of bias; B.V.C: wrote the abstract, participated in the process of screening articles, extracting data, and assessing the risk of bias; M.L.P.B: participated in the process of screening articles, extracting data, and assessing the risk of bias; L.V.M: participated in the process of screening articles, extracting data, and assessing the risk of bias; M.C.P.T: participated in the process of screening articles, extracting data, and assessing the risk of bias; T.V.V: wrote the final version of the manuscript; edited figure 2. D.B.M: was responsible for the conception of the research and final revision of the manuscript. The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: None applicable.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpem-2024-0609).

Received: 2024-12-17
Accepted: 2025-03-12
Published Online: 2025-04-08
Published in Print: 2025-06-26

© 2025 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Pubertal disorders in juvenile idiopathic arthritis: a systemic review
  4. Hormonal therapy for impaired growth due to pediatric-onset inflammatory bowel disease: a systematic review and meta-analysis with trial sequential analysis
  5. Mini Review
  6. Neonatal hypoglycaemia in the offsprings of parents with maturity-onset diabetes of the young (MODY)
  7. Original Articles
  8. Cord blood metabolomic profiling in high risk newborns born to diabetic, obese, and overweight mothers: preliminary report
  9. Impact of Covid-19 on children and adolescents with type 1 diabetes: lifestyle, telecommunication service, and quality of life
  10. The diagnostic utility of bioelectrical impedance analysis in distinguishing precocious puberty from premature thelarche
  11. Infant gonadotropins predict spontaneous puberty in girls with Turner syndrome
  12. Bioinformatics analysis explores key pathways and hub genes in central precocious puberty
  13. Impact of growth hormone therapy on bone and body composition in prepubertal children with idiopathic short stature
  14. Presence of hyperandrogenemia in cases evaluated due to menstrual irregularity, the effect of clinical and/or biochemical hyperandrogenemia on polycystic ovary syndrome
  15. Cardiac function in children with congenital adrenal hyperplasia
  16. Short Communication
  17. Clinical and genetic insights into congenital lipoid adrenal hyperplasia: a case series from a tertiary care center in North India
  18. Case Reports
  19. Two families, two pathways: a case series of 46, XY DSD with 17α-hydroxylase deficiency and isolated 17,20-lyase deficiency due to novel CYB5A variant
  20. Coexistence of SRY, DHX37 and POR gene variants in a patient with 46,XY disorder of sex development
  21. Diabetes, macrocytosis, and skin changes in large-scale mtDNA deletion
https://doi.org/10.1515/jpem-2024-0609
Keywords for this article
growth hormone; inflammatory bowel disease; growth failure

Articles in the same Issue

  1. Frontmatter
  2. Reviews
  3. Pubertal disorders in juvenile idiopathic arthritis: a systemic review
  4. Hormonal therapy for impaired growth due to pediatric-onset inflammatory bowel disease: a systematic review and meta-analysis with trial sequential analysis
  5. Mini Review
  6. Neonatal hypoglycaemia in the offsprings of parents with maturity-onset diabetes of the young (MODY)
  7. Original Articles
  8. Cord blood metabolomic profiling in high risk newborns born to diabetic, obese, and overweight mothers: preliminary report
  9. Impact of Covid-19 on children and adolescents with type 1 diabetes: lifestyle, telecommunication service, and quality of life
  10. The diagnostic utility of bioelectrical impedance analysis in distinguishing precocious puberty from premature thelarche
  11. Infant gonadotropins predict spontaneous puberty in girls with Turner syndrome
  12. Bioinformatics analysis explores key pathways and hub genes in central precocious puberty
  13. Impact of growth hormone therapy on bone and body composition in prepubertal children with idiopathic short stature
  14. Presence of hyperandrogenemia in cases evaluated due to menstrual irregularity, the effect of clinical and/or biochemical hyperandrogenemia on polycystic ovary syndrome
  15. Cardiac function in children with congenital adrenal hyperplasia
  16. Short Communication
  17. Clinical and genetic insights into congenital lipoid adrenal hyperplasia: a case series from a tertiary care center in North India
  18. Case Reports
  19. Two families, two pathways: a case series of 46, XY DSD with 17α-hydroxylase deficiency and isolated 17,20-lyase deficiency due to novel CYB5A variant
  20. Coexistence of SRY, DHX37 and POR gene variants in a patient with 46,XY disorder of sex development
  21. Diabetes, macrocytosis, and skin changes in large-scale mtDNA deletion
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