A Preliminary Study On Gluten Enteropathy Were Screened In Dwarfism Population

Background:Celiac disease (CD) is an immune-mediated enteropathy, induced by dietary gluten in genetically susceptible individuals (either HLA DQ2or DQ8postive).The disorder is characterised by a diverse clinical heterogeneity that ranges from asymptomatic to severly symptomatic. By far, life-long gluten-free diet is the only known effective treatment.Untreated, Celiac disease has the potential to result in various health problems ranging from malabsorption (including various nutrient deficiencis, anemia, and osteoporosis) to autoimmune problems and malignancies.Until fairly recently,celiac disease was considered uncommon even in the Western world,with a prevalence of1/1000or lower. The accuracy of the actual prevalence estimates has been substantially improved by the increased reliability of serological tests—antigliadin antibodies testing (detected and reported by Berger in1964) initially, followed by antiendomysial antibodies and anti tissue transglutaminase antibodies testing. By far, the golden standard for diagnosing celiac disease is intestinal biopsy.The classic pathology change of celiac disease including lymphocytes infiltration in the lamina propria, proliferation of the crypts of Lieberkuhn and partial or complete villous atrophy, categorised by the "Marsh classification".Recent studies from screenings of European and American healthy populations reported a prevalence between1/82and1/300. These studies also implyed that a sizeable proportion of affected individuals remained unrecognized. Celiac disease is said to exist almost all over the world, despite of its scaresity in East Asia including China. Clinical manifestations of celiac disease vary greatly between age groups. Short stature is a well-known feature of pediatric celiac disease (CD). In recent studies, celiac disease was considered a more common cause of short stature in otherwise healthy children than growth hormone deficiency (Sultan M et al.)Objective:This study intended to determine the positive rates of celiac disease specific serological antibodies in the short stature Chinese population.Using intestinal biopsy as the final diagnostic method, we intended to verify whether celiac disease in the short stature Chinese population was as common as in other nations.Methods:According to the inclusive criteria,66children in total (28male,38female,mean age,15.3±3.4years)with short stature (standing height more than2standard deviations below the mean height or below the3rd percentile for gender) were studied as case group, with another75children(35male,40female,mean age15.1±2.1years) of normal stature as control. These two groups were matched in age and gender, and anthropometric parameters were recorded. With informed consents,2ml whole blood samples were collected, centrifugated and stored at-80℃. IgA and IgG Antigliadin antibody (AGA), IgA and IgG tissue transglutaminase antibody (tTG) levels were evaluated by using enzyme-linked immunosorbent assay (ELISA). Subjects with one or more positive results were advised to take endoscopic intestinal biopsy. This study was approved by the Ethics Committee of Peking Union Medical College Hospital.Results:In case group,21cases were diagnosed with Turner syndrome,19cases with idiopathic growth hormone deficiency,4cases with primary hypothyroidism,5cases with autoimmune disorders and another17cases of uncertain pathogensis with idiopathic short stature. The positive rate of IgA AGA in the case group was10.6%compared to 6.7%in the control group (p>0.05). The positive rates of IgG AGA were4.5%and4%(p>0.05) in case and control group, respectively. Three percent of subjects in the case group while none (p>0.05) in the control group were IgA tTG positive. Subjects in neither the case group nor the control group were IgG tTG positive. One subject in the case group was both IgA AGA and IgA tTG positive. Endoscopic intestinal biopsy was performed in4subjects with one or more positive results. Plasma cell increasing and lymphocyte infiltration in the lamina propria were seen in all these patients, representing chronic inflammation of the small intestine. Apparent pathological changes were observed in one patient with widening and shortening of villi in the duodenal bulb, wihle the villi in the descending duodenum seemed almost normal.Conclusions:The positive rates of celiac disease specific antibodies, especially IgA AGA and IgG AGA, were fairly high in both the short stature and the normal stature group. All the four subjects undergoing intestinal biopsy demonstrated some degree of intestinal chronic inflammation, possibly being an early stage pathologic change of celiac disease. The study also implied that serological test was a reliable method for screening and early detection of celiac disease. In additon, the incidence of celiac disease might be much higher in Chinese population than expected, especially in the short stature group.