ESPE Abstracts

Celiac disease (CD) is an intestinal chronic inflammatory and autoimmune disease that develops as a result of interplay between genetic, immunologic, and environmental factors. Many patients, who are referred for evaluation for short stature, show initially no identifiable abnormalities and labeled as having idiopathic short stature (ISS). Children with growth hormone deficiency may show poor response to growth hormone (GH) replacement therapy. In both conditions, this may be due to the co-existence of CD. So the aim of the study to determine the prevalence of CD in Egyptian children diagnosed with idiopathic short stature (ISS) and those with GHD who have showed poor response to GH replacement.

Methods: The study was conducted on (60) children with idiopathic short stature, (40) growth hormone deficient children with poor response to a minimum one year of continuous therapy of growth hormone replacement and (40) healthy children as control group. All groups were included irrespective of whether or not they had any other symptom suggestive of CD. Screening is based on tissue transglutaminase immunoglobulin A (TTG Ig A) test. Total Ig A titer has been done to be sure that it was normal.

Results: showed that the overall prevalence of CD based on serology among ISS and GHD is the same and estimated to be 5 %. TTG Ig A titer was significantly higher in the GHD group than the ISS group and higher in both groups than control one. There were 12 cases with levels of total Ig A <20 mg/dl and were referred to perform TTG IgG serological testing but all were confirmed to be negative. All positive cases were referred to perform confirmatory upper endoscopy and histopathological evaluation. Children with ISS were instructed to initiate GFD while those with GHD were instructed to initiate that diet along with continuation of GH replacement therapy.

Conclusion: screening of CD must be done as a routine investigation in children with either ISS or GHD before start of therapy.