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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.

    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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    This makes me feel a lot better. I am 20 years old and only made it to 5' which was a source of teasing since 6th grade but I was never tested for anything because I was half Hispanic so it was assumed that was why I was so short. I was diagnosed about 5 months ago and this is the first I have heard about short stature being connected with the disease. Thank you so much for this!

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    My daughter has been on a gluten free diet for almost 3 years and has grown approximately 6 inches from total growth arrest. She is now 15. There is a need for mandatory testing!

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    I have just added this page to my Favorites. I have a 3-year-old who is in the category of failure to thrive. He tested positive for his endocrine screening and we will be asking his doctor to look into celiac disease and test for that. We are worried, but are hopeful. Thanks for this information! It has helped a great deal in understanding a little bit more about celiac disease as it relates to children.

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    I am 4'10 and the average height for other females in my family is 5'4.5" this is mom, aunts and a sister. All run between 5"3 and 5'6". My brother is a full foot taller than I am and we have the same parents. I have had bowel issues as long as I can remember and host of symptoms that seem autoimmune for about 7-0 years but bad for about 7. I was finally diagnosed with Fibro and IBS when they couldn't find anything else. NOT ONE of the four Dr's I saw ever thought of gluten. Then on vacation I landed in the ER after indulging in lots of yummy carbs I normally wouldn't eat much. The DR there acted like I was stupid I hadn't found it my research but it never came up in symptom checker or anything. Lactose did but the diet made very little difference. My Dr., who is actual fab, felt awful but I was already going gluten free by my follow up so while it seem s obvious I have gluten issue I may never know if I am celiac. PS I feel awesome, poop great and have very little pain or swelling anymore, and no headaches!

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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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