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  • Kathleen La Point
    Kathleen La Point

    Screening Children of Short Stature for Celiac Disease

    Reviewed and edited by a celiac disease expert.

    This article appeared in the Winter 2008 edition of Celiac.com's Scott-Free Newsletter.

    Celiac.com 12/20/2007 - Celiac disease is under-diagnosed because many celiac disease patients do not show classic gastrointestinal symptoms. Highly sensitive and specific serological tests have led to the diagnosis of celiac disease in patients for whom short stature may be the only obvious symptom. Researchers from Brazil and Italy have previously reported that celiac disease accounts for 1-5% of short stature in children.


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    Prevalence of celiac disease varies widely according to geographic location. Although epidemiological studies are lacking in India, celiac disease reporting has increased exponentially due to targeted screening and better serological tests. To better understand the relationship between short stature and celiac disease, researchers from the Endocrine Clinic of the Postgraduate Institute of Medical Education and Research in Chandigarh studied children referred for a work-up of short stature from January 2005 to December 2006.

    Researchers enrolled 176 patients, half male and half female, who fit the criteria for short stature: height ≥ 2.5 standard deviations below the mean for chronological age, growth rate below the fifth percentile for chronological age, and height ≥ 2 standard deviations below mean for chronological age when corrected for mid-parental height. Most patients were 10-15 years old (mean age of 14.5).

    Researchers took detailed histories and carried out clinical evaluations and screening tests. If they could find no endocrine cause for short stature or if diarrhea had been present for more than 3 months, researchers estimated IgA anti-tissue transglutaminase antibodies (anti-tTG) and performed an endoscopic biopsy.

    Celiac disease was found in 27 (15.3%) of the patients, making it the single most common cause of short stature. 25 children had pituitary disorder (14%), 24 had hypothyroidism (14%), and constitutional delay of growth and puberty or  familial short stature accounted for 18 (11%). Other less common causes of short stature were metabolic bone disease, Turner syndrome, adrenal disorders, diabetes mellitus, and nutritional deficiency. All celiac disease patients were positive for tTG antibodies and had a duodenal biopsy suggestive of celiac disease. All celiac disease patients were symptomatic; the most common symptoms after growth retardation were anemia (88%), weight loss (80%), diarrhea (69%), and delayed puberty (54%).

    The average time to diagnosis for these patients was 5.5 years (95% cI: = 2.5 to 8.5 years). The celiac disease patients were treated with a gluten-free diet, calcium (500 mg/day), vitamin D (300,000 U cholecalciferol once every 3 months), and iron and multivitamin supplementation including folic acid and vitamin B12. During the 6-9 month follow-up period, growth rate velocity increased significantly from  2.9 cm/year (95%  cI = 2.41 to 3.39 cm/year) to 8.9 cm/year (95% cI = 6.7 to 11.1 cm/year).

    Celiac disease can lead to short stature by causing autoimmune hypothydroidism, resistance to growth hormones, and malabsorption of protein, calcium and vitamin D. Additionally, celiac disease can lead to hypogonadism which inhibits the pubertal growth spurt. Researchers recommend that all short children be screened for celiac disease.

    Resources
    Bhadada, S. Bhansali, A., Kochhar, R., Shankar, A., Menon, A., Sinha, S., Dutta, PP., and Nain, C. Does every short stature child need screening for celiac disease? Gastroenterology [OnlineEarly Articles]. doi:10.1111/j.1440-1746.2007.05261.x


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    I was born in 12/1948 in Detroit Michigan. I was taken to the doctor when I was about 2 or so because I had quit growing. After another 18 months I was diagnosed with celiac. I was also diagnosed with hypothyroid at age of 6. I was under physician care at Henry Ford Hospital (I was adopted at age 8 and the medical permanency of the celiac was not given to new family). Thus I went 55 years before finding out I never got rid of celiac. I had many, many health issues until few years ago.

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    I am so excited to see this article because it supports what I was trying to tell my pediatrician regarding my sons short stature. My son is on a gluten-free diet for a year and we are not seeing enough progress therefor I consulted with a nutritional consultant who is a medical practitioner and she had recommended Vitamin D and B12 testing to check for absorption on top of all the other testing now I am waiting for results.

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    Guest Ragini Sreenivas

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    Ever since I was young I always seemed to suffer from stomach disorders. About 6 years ago it got worse and I underwent X-rays and sonography. The latter showed hyperplasia of lymph nodes and my doctor suspected autoimmune disease or food allergy. He asked me to avoid wheat and its products and then the diarrhea stopped. I am short and my weight is below normal.

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    Routine testing for celiac in children with growth problems should be encouraged. It is done in Spain by the national health service and this is how my daughter was diagnosed. She had always been average height but at 11 she didn't keep up with average growth spurts. A battery of standard blood tests was done (among them the one for celiac) and she was diagnosed. She had no other visible symptom except very indefinite pains here and there that doctors had taken no notice of but the biopsy results showed a very damaged intestine. So if the routine test had not been done, who knows when and in what conditions we would have found out! I am very grateful to our system for this.

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    All articles that help with celiac are EXCELLENT! Let's not forget the third of adults that are obese at diagnoses. When I was an infant I had nausea all the time, and was one of the biggest tallest kids growing up, and I had rashes that they said I would outgrow. I was disgnosed via a biopsy at age 38, I now believe that I had it all my life. Too many signs to list here. Thank you for your website! I would bet a million dollars my son's doctor has never been on this site, even with the articles I give him.

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    I learned of Celiac when a good friend told me she had it at our 25-year high school reunion. She had symptoms in high school and took 20+ years to get the correct diagnosis.

     

    Short stature was the primary reason that I took my 10-year old son for testing. He had no other symptoms, except slight anemia at his last checkup just a couple of months earlier. He tested positive for Celiac. As we got his blood work down to negative with the gluten-free diet, his growth improved somewhat, but he was still below 2.5 standard in height at age 13 (Mom and Dad slightly above average height). After not seeing catch-up growth after 3 years on the gluten-free diet, he has started growth hormones. We are seeing positive response and a steep change in growth rate.

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    Only three days ago, a friend was talking about the short stature of his grandson who happens to have respiratory problems as well. He didn't mention his dietary intakes and I wasn't aware of the damages gluten-loaded diet can do. I'll pass this article to my friend and wait for any outcomes and will inform you of developments. Thanks

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  • About Me

    Kathleen LaPoint is a biomedical writer with a B.S. in Molecular Biology and an M.S. in Bacteriology from the University of Wisconsin - Madison.

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