Celiac disease (CeD) is an immune-mediated enteropathy induced by gluten exposure in individuals with genetic susceptibility. Short stature (SS) can be the sole clinical manifestation of CeD, in the absence of gastrointestinal (GI) symptoms. This study aimed to determine the prevalence of CeD in Saudi Arabian children with SS.
Patients and methods
Medical records were reviewed in a total number of 275 retrospective cases (during the period 2002–2014) of children with isolated SS from King Abdulaziz University Hospital, Jeddah. Their serum samples were tested with tissue transglutaminase (tTG) antibodies. Patients with a positive serology were scheduled for an upper endoscopy and intestinal biopsy to confirm CeD diagnosis before starting a gluten-free diet (GFD). Clinical, anthropometric and laboratory data were recorded for all patients.
A total of 275 children with SS were included. The mean age ± standard deviation (SD) was 9.4 ± 4.0 years (range, 2.6–16.9 years) and males constituted the predominant gender group (151/275; 54.9%) over females (124/275; 45.1%). The mean ± SD height for age z score (HAZ) was −2.9 ± 1.0.Thirty-eight (13.8%) had positive serology, and 16 (5.8%) had biopsy-proven CeD. Apart from the difference in duration of delayed bone age between CeD patients and CeD-negative serology subjects (mean ± SD, 39.6 ± 10.5 vs. 18.6 ± 16.8, p = 0.02), no other major difference in other clinical or laboratory parameters was evident.
The prevalence rate of CeD in Saudi Arabian SS children was 5.8%, which is comparable to published reports of a number of other countries. Regular screening of children with SS is therefore justifiable.
The authors would like to thank Dr. Trevor Rawbone, Cardiff, UK for English language editing of the manuscript.
Author contributions: Development of study concept and design: NA and OS. Acquisition, analysis and interpretation of the data: NA and OS. Statistical analysis: OS. Drafting of the manuscript: NA and OS. Approval of final manuscript: all NA and OS.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012;54:136–60.10.1097/MPG.0b013e31821a23d0Search in Google Scholar
3. Rewers M. Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology 2005;128(4 Suppl 1):S47–51.10.1053/j.gastro.2005.02.030Search in Google Scholar
4. Al Hatlani MM. Prevalence of celiac disease among symptom-free children from the Eastern Province of Saudi Arabia. Saudi J Gastroenterol 2015;21:367–71.10.4103/1319-3767.170952Search in Google Scholar
5. Al-Hussaini A, Troncone R, Khormi M, AlTuraiki M, Alkhamis W, et al. Mass screening for celiac disease among school-aged children: toward exploring celiac iceberg in Saudi Arabia. J Pediatr Gastroenterol Nutr 2017;65:646–51.10.1097/MPG.0000000000001681Search in Google Scholar
6. Cronin CC, Shanahan F. Exploring the iceberg – the spectrum of celiac disease. Am J Gastroenterol 2003;98:518–20.Search in Google Scholar
7. Makharia GK, Baba CS, Khadgawat R, Lal S, Tevatia MS, et al. Celiac disease: variations of presentations in adults. Indian J Gastroenterol 2007;26:162–6.Search in Google Scholar
8. Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of subclinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol 1999;94:691–6.10.1016/S0002-9270(98)00819-3Search in Google Scholar
9. Damen GM, Boersma B, Wit JM, Heymans HS. Catch-up growth in 60 children with celiac disease. J Pediatr Gastroenterol Nutr 1994;19:394–400.10.1097/00005176-199411000-00005Search in Google Scholar PubMed
11. van Rijn JC, Grote FK, Oostdijk W, Wit JM. Short stature and the probability of coeliac disease, in the absence of gastrointestinal symptoms. Arch Dis Child 2004;89:882–3.10.1136/adc.2004.057851Search in Google Scholar PubMed PubMed Central
13. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, et al. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7.10.2471/BLT.07.043497Search in Google Scholar PubMed PubMed Central
14. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age w-f-a, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: World Health Organization, 2006 (312 p.).Search in Google Scholar
15. Marsh MN, Johnson MW, Rostami K. Rebutting Oberhuber- Again. Gastroenterol Hepatol Bed Bench 2015;8:303–5.Search in Google Scholar
16. Greulich WWP SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd edn ed. Stanford, CA: Stanford University Press; 1959.10.1097/00000441-195909000-00030Search in Google Scholar
17. Giovenale D, Meazza C, Cardinale GM, Sposito M, Mastrangelo C, et al. The prevalence of growth hormone deficiency and celiac disease in short children. Clin Med Res 2006;4:180–3.10.3121/cmr.4.3.180Search in Google Scholar PubMed PubMed Central
19. Hussein A, Farghaly H, Askar E, Metwalley K, Saad K, et al. Etiological factors of short stature in children and adolescents: experience at a tertiary care hospital in Egypt. Ther Adv Endocrinol Metab 2017;8:75–80.10.1177/2042018817707464Search in Google Scholar PubMed PubMed Central
20. Singh P, Sharma PK, Agnihotri A, Jyotsna VP, Das P, et al. Coeliac disease in patients with short stature: a tertiary care centre experience. Natl Med J India 2015;28:176–80.Search in Google Scholar
21. Street ME, Volta C, Ziveri MA, Zanacca C, Banchini G, et al. Changes and relationships of IGFS and IGFBPS and cytokines in coeliac disease at diagnosis and on gluten-free diet. Clin Endocrinol (Oxf) 2008;68:22–8.10.1111/j.1365-2265.2007.02992.xSearch in Google Scholar PubMed
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