Short stature and celiac disease: A relationship to consider even in patients with no gastrointestinal tract symptoms

Cacciari, E; Salardi, S; Lazzari, R; Cicognani, Alessandro; Collina, A; Pirazzoli, Piero; Tassoni, P; Biasco, Guido; Corazza, Gino Roberto; Cassio, Alessandra

doi:10.1016/s0022-3476(83)80462-4

Cited by 95 publications

(53 citation statements)

References 10 publications

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“…A forma não clássica da DC manifesta-se mais tardiamente, com quadro mono ou paucissintomático. Os pacientes deste grupo podem apresentar manifestações isoladas, como por exemplo baixa estatura [10][11][12][13] , anemia por deficiência de ferro refratária à ferroterapia oral [14][15][16] , hipoplasia do esmalte dentário [17][18][19] , constipação intestinal 20 , osteoporose 21 , esterilidade 22 , artralgia ou artrite 23 e epilepsia associada a calcificação intracraniana 24 . O reconhecimento da forma assintomática da doença, especialmente entre familiares de primeiro grau de pacientes celíacos 25 , tornou-se mais fácil a partir do desenvolvimento de marcadores sorológicos específicos para a DC 26,27 .…”

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Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association

2001

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ResumoObjetivo: avaliar as características clínicas e os métodos utilizados no diagnóstico dos pacientes cadastrados na Associação dos Celíacos do Brasil -Seção São Paulo.Métodos: foi enviado por correio um questionário a respeito das características clínicas e dos métodos diagnósticos da doença celí-aca para 584 membros cadastrados.Resultados: foram analisados 289 questionários respondidos (49,5%) dos 584 enviados. Quanto às características clínicas da doença celíaca no momento do diagnóstico, observou-se que na amostra estudada a forma clássica foi mais freqüente (88,9%) do que a forma não clássica (11,1%). Nos últimos cinco anos houve aumento da proporção da forma clássica tardia de 44,5% para 64,2% (p=0,004) e da forma não clássica de 5,2% para 16,8% (p=0,005). O tempo de duração dos sintomas até o estabelecimento do diagnóstico foi superior a 1 ano em 75% dos pacientes com manifestação clínica não clássica. Biópsia de intestino delgado não foi realizada no momento do diagnóstico em 19% dos pacientes. Observou-se que, nos últimos 5 anos, maior número de pacientes (24,4%) não realizaram biópsia de intestino delgado no momento do diagnóstico em relação aos realizados há 5 ou mais anos (11,1%) (p=0,007).Conclusões: na amostra estudada, a forma clássica continua sendo a manifestação clínica mais freqüente da doença celíaca. Apesar do predomínio da forma clássica tardia, observamos aumento da proporção da forma não clássica. 19% dos pacientes diagnosticados como portadores de doença celíaca não realizaram biópsia de intestino delgado no momento do diagnóstico, especialmente nos últimos 5 anos, apesar de a caracterização da atrofia vilositária subtotal ou total da mucosa do intestino delgado ser um critério imprescindível para o diagnóstico de doença celíaca.J Pediatr (Rio J) 2001; 77 (2): 131-8: doença celíaca, sinais e sintomas, diagnóstico, diarréia, desnutrição protéico-energética. AbstractObjective: to evaluate the clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association (BCA).Methods: a questionnaire about clinical characteristics and diagnostic methods in celiac disease was mailed to 584 members of the BCA.Results: we received 292 responses for 584 questionnaires mailed (49.5%). The clinical characteristics of celiac disease in the sample we analyzed showed that the most frequent type was the classical mode (88.9%), while the atypical mode was present in only 11.1% of patients at the time of diagnosis. Increased incidence of both late diagnosed classical mode (44.5% to 64.2%; P=.004) and atypical mode (5.2% to 16.8%; P=.005) has been observed in the last 5 years. Duration of symptoms before diagnosis was greater than 1 year in 75% patients with atypical manifestation. Intestinal biopsy was not performed in 19% of the cases at the time of diagnosis. It was observed that in the last 5 years intestinal biopsy was not performed for a larger number of patients (24.4%) than in the previous period (only 11.1%) (P=.007).Conclusions: classical mode is stil...

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Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association

2001

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“…Some studies have shown that short stature and/or low growth rate can be the primary or even the only manifestations of CD (3,6) , the same occurring in non classical TS presentation (19,30) . This observation strengthens the rationale for screening for both CD and TS when investigating girls with short stature and/or failure to thrive.…”

Section: Discussionmentioning

confidence: 99%

Screening for celiac disease among patients with Turner syndrome in Brasília, DF, midwest region of Brazil

Dias

Castro

Gandolfi

et al. 2010

Arq. Gastroenterol.

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-Context -Several studies have demonstrated a higher prevalence of celiac disease (CD) among females with Turner syndrome when compared to the general population. Nevertheless, there is no record in literature concerning this investigation among Brazilian patients. Objective -To assess the prevalence of CD among a group of Brazilian patients with Turner syndrome. Methods -Fifty-six females with Turner syndrome and on gluten-containing diet were screened for CD utilizing immunoglobulin A antiendomysium (IgA-EMA) and immunoglobulin A anti-tissue transglutaminase (IgA-tTG) antibody assays. Additionally, they were genotyped for CD human leukocyte antigen (CD-HLA) predisposing alleles. Patients showing positivity in serological testing were offered to perform small intestine biopsy for histological confirmation. Results -Mean age at diagnosis of Turner syndrome was 5.5 ± 4.4 years; mean age at screening for CD was 17.0 ± 9.3 years (from 10 months of age to 52 years). Two girls were positive for IgA-EMA and IgA-tTG, presented predisposing HLA-DQ2 alleles and both had the diagnosis of CD confirmed by jejunal biopsy. Conclusion -The 3.6% prevalence of biopsy-proven CD among this group of females with Turner syndrome is 10 times higher than the one among females from the general population of the same geographical area. This result provides additional support to an association between these two disorders and restates that girls and women with Turner syndrome represent a high risk population for developing CD.

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“…Previous studies on children with growth failure but without gastrointestinal symptoms have shown a variable incidence of celiac disease (0 to 59.0%) depending on the region where the study was performed (18)(19)(20)(21)(22)(23)(24)(25). All patients with a diagnosis of celiac disease showed an improvement in growth velocity after the introduction of a gluten-free diet, indicating that this parameter would be useful to confirm the correct diagnosis, as also reported by others (19,23,26). Unfortunately, the patient diagnosed as having potential celiac disease (13,27) because of a positive result in the antiendomysial antibody test and no histological abnormalities was lost to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Five children diagnosed as having celiac A review of the literature (5,18,19,21,(33)(34)(35)(36) led us to conclude that there is no single parameter suggesting the presence of celiac disease in children of short stature. Our data support the view that there is no single test or measurement that can identify all subjects with celiac disease, with the occurrence of even a few false-positive results.…”

Section: Discussionmentioning

confidence: 99%

“…There are reasons to believe that nutritional deficiencies can result in growth failure associated with changes in hormonal status such as poor GH release in a stimulatory test (18,19) and low levels of IGF1 (5). Eichler et al (37) found a strong relationship between the duration of gluten exposure and reduced IGF1 levels and concluded that reduction in IGF1 levels occurs only after prolonged exposure to gluten.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of celiac disease in Brazilian children of short stature

Queiroz

Nery

Cançado

et al. 2004

Braz J Med Biol Res

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The aim of the present study was to determine the prevalence of celiac disease in children of short stature and to assess whether some of the routine laboratory examinations performed to determine the cause of short stature could suggest the presence of celiac disease. A total of 106 children of short stature and no gastrointestinal symptoms were studied. An extensive endocrine work-up had been negative for all of them and an additional investigation was performed by measuring the concentration of antiendomysial antibody. Patients who were positive for antiendomysial antibody (≥1:10) or who exhibited IgA deficiency (less than 5 mg/dl) were referred for an endoscopic intestinal biopsy.

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Short stature and celiac disease: A relationship to consider even in patients with no gastrointestinal tract symptoms

Cited by 95 publications

References 10 publications

Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association

Celiac disease: clinical characteristics and methods used in the diagnosis of patients registered at the Brazilian Celiac Association

Screening for celiac disease among patients with Turner syndrome in Brasília, DF, midwest region of Brazil

Prevalence of celiac disease in Brazilian children of short stature

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