title: Isolated short stature as a presentation of celiac disease in Saudi children.
abstract: The aim of this study is to assess the prevalence of isolated short stature as a clinical presentation of celiac disease in Saudi Arab children and whether some of the routine laboratory tests performed to determine the cause of short stature could suggest the diagnosis of celiac disease. A total of 91 children with short stature were included in the study. Extensive endocrine and biochemical assessments, including total protein, serum albumin, calcium phosphate and alkaline phosphatase assays; renal function tests; coagulation profile; anti-endomysial antibodies and anti-tissue transglutaminase antibody, growth hormone, thyroid stimulating hormone, free-thyroxin (FT4) assays; stool tests for giardiasis; bone age; and endoscopic intestinal biopsies, were done for all children. Ten of the 91 children had positive intestinal biopsies in the form of total villous atrophy, an increase in crypt height, and an increase in intra-epithelial lymphocyte (IEL) numbers up to >40 IEL/100 EC (Type 3C) according to the Oberhuber classification, confirming the diagnosis of celiac disease. Five children had mild villous atrophy according to this classification (Type 3A), and they were considered to have potential celiac disease. Seventy-six children had normal intestinal biopsies. Therefore, the prevalence of celiac disease among Saudi children with short stature was 10.9%, and 4.3% of the children were diagnosed as having potential celiac disease. After confirming the diagnosis of celiac disease, all children were kept on a gluten-free diet and all of them showed improvement in their growth rate. We concluded that celiac disease is a very important cause of short stature in children without gastrointestinal complaints in Saudi Arabia. We highly recommend anti-tissue transglutaminase and anti-endomysial antibody screening tests, and a small bowel biopsy to confirm the diagnosis of celiac disease irrespective of the results of the antibody assays, in children with short stature in Saudi Arabia. Once the diagnosis is confirmed, children should be kept on a gluten-free diet so they can catch up their growth early before they develop permanent short stature.
authors: Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
authors: Asaad Mohamed Abdullah
authors: AM
authors: Assiri
references: N Engl J Med. 2002 Jan 17;346(3):180-8
references: 11796853
references: J Pediatr Gastroenterol Nutr. 1999 Sep;29(3):339-42
references: 10468002
references: Klin Wochenschr. 1991 Nov 15;69(18):825-9
references: 1770750
references: J Pediatr Gastroenterol Nutr. 1990 Oct;11(3):324-9
references: 2246713
references: Lancet. 1980 Nov 22;2(8204):1097-9
references: 6107721
references: Helv Paediatr Acta. 1978 Dec;33(6):489-95
references: 216652
references: J Pediatr. 1983 Nov;103(5):708-11
references: 6631596
references: J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):12-6
references: 1573504
references: J Pediatr Gastroenterol Nutr. 1991 Feb;12(2):190-4
references: 2051271
references: Gastroenterology. 2001 May;120(6):1522-5
references: 11313323
references: J Pediatr. 1993 Aug;123(2):262-4
references: 8345423
references: Arch Dis Child. 1990 Aug;65(8):909-11
references: 2205160
references: Eur J Epidemiol. 1997 Jan;13(1):55-9
references: 9062780
references: Eur J Gastroenterol Hepatol. 1999 Oct;11(10):1185-94
references: 10524652
references: An Esp Pediatr. 1992 Oct;37(4):304-6
references: 1443939