ESPE Abstracts

Up to 10 % of short stature has been estimated to be due to celiac disease. Celiac disease has been considered a rare condition outside of the Western world but recent publications (Singh P et al, Clin Gastroenterol Hepatol 2018 Jun 16 (6): 823-836, Yuan J et al, Clin Gastroenterol Hepatol 2017 Oct;15(10): 1572-1579) have shown that celiac disease is also present in Asians. While Tissue Transglutaminase IgA (tTg-IgA) has been considered to be a sufficiently sensitive test to exclude celiac disease on its own, a recent paper (Hujoel IA et al, J Clin Gastroenterol 2021;55: 327-334) argues that its sensitivity has been over-estimated due to a failure to account for verification bias. I have observed that many patients who consulted me for problems of short stature and endocrine disorders have had positive serology for celiac disease. Over an 8 year period from 2012 -2020, 456 patients (including 150 Singaporeans), were found to be positive for one or more celiac serology tests as defined by kit manufacturer’s standards (Euroimmun for tTg-IgA, DGP IgA and DGP IgG, Orgentec for tTg-IgG) and performed at a single government hospital lab(TTSH Clinical Immunology Laboratory). The 456 patients, of whom Males 243, Females 213, and 395 were <19 yrs old, comprised 230 ethnic Chinese, 80 Caucasians, 40 Indians, 22 Indonesian/Malay and 84 others. The vast majority (380) came for some form of growth disorder, eg short stature, growth faltering, or lack of a normal pubertal growth spurt, while 34 had Type 1 diabetes mellitus, 28 were screened because of a positive 1st degree relative and 14 presented for a thyroid condition. Many but not all had GIT symptoms. Of 115 patients positive for Ttg-IgA, 98 (85%) were <19 yrs at presentation and came mainly for growth issues. Of the 98 TTg-IgA positive patients < 19yrs of age, 44% are of Chinese origin, 23.5% are of Caucasian origin, and 71.5% are of broadly Asian origin. Among 217 patients positive for Ttg igG, 50% were ethnic Chinese vs Caucasians (13%). There were 251 patients positive for DGP IgA, (135 ethnic Chinese, 45 Caucasians), and 46 positive for DGP IgG (11 Caucasians). A total of 4 patients were positive for all 4 antibodies, 18 were positive for 3 antibodies and 40 were positive for 2 out of 4 tests. The association of positive Celiac Disease serology and growth impairment is not uncommon in Singaporeans and Asians.