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Screening Children of Short Stature for Celiac Disease

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).

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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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16 Responses:

 
Sandra Haste
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said this on
25 Dec 2007 4:51:43 PM PDT
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.

 
Rivka
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said this on
01 Jan 2008 1:32:06 AM PDT
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.

 
an unknown user
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said this on
01 Jan 2008 8:44:34 AM PDT
Very interesting!

 
an unknown user
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said this on
01 Jan 2008 10:59:29 AM PDT
This confirms what I have suspected for quite a while. Thank you.

 
Ragini Sreenivas
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said this on
01 Jan 2008 5:04:24 PM PDT
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.

 
ikram
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said this on
01 Jan 2008 9:07:11 PM PDT
very good. My daughter is 5 years old and has been gluten free diet for six months and she is improving.
I would like to have anything new on the issue--thanks.

 
guadalupe
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said this on
02 Jan 2008 12:26:58 AM PDT
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.

 
Tina
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said this on
02 Jan 2008 8:38:19 AM PDT
Thank you so much. We are getting our son tested for this. I have changed his diet and he is doing much better.

 
rick
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said this on
02 Jan 2008 11:12:31 AM PDT
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.

 
Bev
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said this on
02 Jan 2008 11:21:13 AM PDT
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.

 
Joseph
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said this on
14 Jan 2008 2:42:01 AM PDT
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

 
Katherine Ulrich
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said this on
09 Feb 2008 9:41:17 AM PDT
I have several grand children and great grand children whom I suspect have this from me, but can't get them to be interested. I have tried and about given up.

 
Ariel
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said this on
21 Mar 2008 6:52:59 AM PDT
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!

 
louise foucek
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said this on
26 Nov 2008 2:18:26 PM PDT
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!

 
M Rockwell
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said this on
11 Jan 2010 12:31:35 AM PDT
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.

 
Lyn
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said this on
01 Jun 2013 2:51:40 PM PDT
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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Hello and welcome Maybe? From reading others accounts there's a big variation in how quickly gluten antibodies respond to the gluten diet. I did similar to you and my doctor said that 1 week back on should be enough to show up in a test, but he didn't know what he was talking about sadly... The 2 week figure refers to the endoscopy, for blood testing 8-12 weeks on gluten is more normal. Basically if it comes back positive fine you have your answer. If its negative it may be a false negative due to your going gluten free beforehand. If you want to pursue a diagnosis then yes. Don't go off gluten again until you confirm that all testing is complete. Keep a journal noting any symptoms, that may be useful to you later. More info here: There's some good info in the site faq: https://www.celiac.com/gluten-free/announcement/3-frequently-asked-questions-about-celiac-disease/ I know how you feel! Partway through my gluten challenge I knew that too results notwithstanding. Fwiw I think you've found your answer. Good luck!

Learn more about testing for celiac disease here: http://www.cureceliacdisease.org/screening/ You do have to be on a gluten diet for ANY of the celiac tests (blood and biopsy) to work. While the endoscopy (with biopsies) can reveal villi damage, many other things besides celiac disease can cause villi damage too: http://www.cureceliacdisease.org/faq/what-else-can-cause-damage-to-the-small-intestine-other-than-celiac-disease/ So, both the blood test and endoscopy are usually ordered. There are some exceptions, but those are not common.

Exactly what are your allergy symptoms? Were they IgG or IgE? Allergy testing as a whole is not super accurate -- especially the IgG. Were you on any H1 or H2 antihistamines for the last five days when you were tested? As far as celiac testing, four days without consuming gluten probably would not impact testing.

I've been seeing my dr for a few weeks now about my stomach issues. We've ruled out the gallbladder and h-pylori and today I had the celiac blood tests done. From the reading I've done the past two days, it seems to me that it's highly likely that I have it. I've had digestive issues for years, but they've gotten progressively worse over the past 6 months or so. Pain and nausea when eating, bloat, eternal constipation, dh rash, at it's worse, tight cramp-like pain in a fist under my sternum, radiating through my back and around my right side keeping me up at night. Also heartburn/reflux and trouble swallowing, etc. Anyway, about 2 months ago, I needed a change. I didn't go to the dr immediately because it seemed pointless. (I've mentioned stomach ache when eating to drs before and been blown off.) So, I started the Whole30 elimination diet (takes out soy, grains, dairy, peanuts, and leaves you basically eating meat & veggies). Figured it would show me what I needed to take out of my diet and hopefully feel better. It worked- I felt great! And it seems that grains and gluten are my biggest offenders. But, now I've been off gluten prior to celiac testing. It's been 7 weeks. After 4 weeks I tested steal cut oats, that I later found out were probably glutened. And then nothing until yesterday. Yesterday I had 2 pieces of bread and a muffin and today I had two pieces of bread and then the blood test. Is this going to be enough to show up on the tests? My dr said that it would probably show up, since I had some yesterday and today and was currently having symptoms. But, google seems to say that I should be glutened for 2 wks straight before testing. Has anyone tested positive after just a little gluten? If it's negative should I insist on doing it again after weeks back on gluten? I feel awful, but do want clear answers. Obviously, gluten's not going to be a part of my life any more either way.

So just to clarify had not consumed any gluten for about 4 days before testing. I was assured by my allergist that it wouldn't affect the test. But what was alarming was that she retested my food allergies (my most recent reaction was two weeks ago) and every food allergy I have came back negative. I don't understand how that is possible. These food allergies developed when I was 20 and I am almost 24 now.