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[Celiac disease as a cause of short stature in children]
J Zapletalová1, A Kolek, J Venhácová
1Dĕtská klinika FN, Olomouc.
Insights
Undiagnosed chronic intestinal disease, like celiac disease, can cause growth retardation in children. Early diagnosis via antigliadin antibody testing and a gluten-free diet significantly improves growth rates and bone maturation.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Immunology
Context:
- Growth retardation is a key indicator of potential undiagnosed chronic intestinal diseases in children.
- Classical causes of short stature often overshadow less common etiologies like celiac disease.
Purpose:
- To investigate the role of antigliadin antibodies in diagnosing oligosymptomatic celiac disease presenting as growth retardation.
- To evaluate the impact of a gluten-free diet on growth and bone maturation in children with celiac disease.
Summary:
- Screening for antigliadin antibodies identified celiac disease in 8 out of 168 children with significant growth retardation and delayed bone age.
- Implementing a gluten-free diet led to a marked improvement in growth rate (from 3.9 to 9.0 cm/year) and bone maturation within one year.
- Enterobiopsy is crucial for confirming the diagnosis after positive antibody screening, and dietary adherence is vital for therapeutic success.
Impact:
- Highlights the importance of considering celiac disease in the differential diagnosis of short stature.
- Demonstrates that early diagnosis and gluten-free dietary intervention can significantly improve growth outcomes in affected children.
- Provides evidence for the efficacy of serological screening and subsequent biopsy in managing pediatric celiac disease.
Background:
Growth retardation may be the only clinical manifestation of undiagnosed chronic intestinal disease. Therefore we have to consider also this etiology in the differential diagnosis of classical causes of short stature in children with typical clinical and laboratory findings.
Methods And Results:
Among 168 patients aged 5.5-17.2 years up to June 1, 1993 on the records of the Paediatric Clinic in Olomouc on account of marked growth retardation (< or = 2 SDS) associated with retarded bone age were eight children where based on screening for antigliadin antibodies the suspicion of coeliac disease was expressed. By introduction of a gluten-free diet the growth rate improved markedly in almost all patients already during the first six months. After a one-year follow-up it increased to 9.0 +/- 1.1 cm from 3.9 +/- 1.3 cm, and concurrently a corresponding progression of ossification occurred. An exception was only a 14-year-old girl who did not comply and did not adhere to the diet.
Conclusion:
In the early diagnosis of oligosymptomatic coeliac disease with a low growth rate as the dominant symptom a key role is played by assessment of antibodies against gliadin. If the results are positive, enterobiopsy is indicated which alone can confirm the diagnosis. Dietetic provisions (a gluten-free diet) improve the growth rate and bone maturation.