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Hormonal therapy for impaired growth due to pediatric-onset inflammatory bowel disease: a systematic review and
Mardhen Catunda Rocha Melo1, Rian Vilar Lima1, Maryana Modena Strada1
1Department of Medicine, University of Fortaleza, Fortaleza, Ceará, Brazil.
Insights
Growth hormone (GH) therapy shows promise in improving linear growth for children with inflammatory bowel diseases (IBD). This study suggests GH is effective and safe for pediatric IBD patients experiencing growth impairment.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Clinical Research
Background:
- Inflammatory bowel diseases (IBD) are increasingly diagnosed in children, often causing growth impairment due to malabsorption.
- The efficacy and safety of growth hormone (GH) therapy for growth deficits in pediatric IBD patients remain under investigation, with existing studies yielding conflicting results.
Purpose of the Study:
- To systematically evaluate the effectiveness and safety of growth hormone (GH) therapy in children diagnosed with inflammatory bowel diseases (IBD) and associated growth impairment.
- To synthesize evidence from existing experimental studies and conduct a trial sequential analysis (TSA) to determine the robustness of findings.
Main Methods:
- A systematic literature search was conducted across MEDLINE, Embase, and Cochrane Library databases following PRISMA guidelines.
- Included were experimental studies on children with IBD receiving GH therapy. A TSA was performed to assess the required sample size for outcomes.
- Data from eight studies involving 127 patients (78 on GH therapy) with a mean follow-up of 1.3 years were analyzed.
Main Results:
- GH therapy significantly increased height standard deviation score (HtSDS) in children with IBD (SMD=1.07, p<0.0001), though not when compared to controls (SMD=0.18, p=0.70).
- Longer follow-up duration correlated with greater HtSDS improvement (p=0.04). Height velocity (HV) significantly increased both within-patient (MD=4.09, p<0.0001) and compared to controls (MD=4.47, p=0.0003).
- No significant changes in disease activity (PCDAI) were observed. Adverse effects occurred in 15.51% of patients, primarily injection site itching. TSA indicated a low risk of estimation bias.
Conclusions:
- Growth hormone (GH) therapy appears effective and safe for managing growth impairment in pediatric patients with inflammatory bowel diseases (IBD).
- Further high-quality randomized controlled trials (RCTs) with standardized methods and extended follow-up are warranted to solidify these findings.
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.
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