Table 1

 Relation of short stature and coeliac disease

Citation, countryStudy groupStudy type (level of evidence)OutcomeKey resultsComments
Knudtzon et al (1991), Norway1168 children (50 girls; 93 boys; age 0.5–17.2 years) with short stature without significant abdominal symptomsProspective cohort study (level 2b)Proportion of coeliac disease in the study group2.9% (5/168) of the children with short stature were diagnosed as having coeliac disease“Short stature” was not defined Results are not internally consistent Diagnosis was not based on ESPGAN-criteria
Stenhammer et al (1986), Sweden287 children (32 girls, 55 boys; age 1.0–16.5 years) with short stature (height more than 2SD below the mean for age and sex) and no gastrointestinal symptoms, signs of systemic disease or malabsorptionProspective cohort study (level 1b)Proportion of coeliac disease in the study group5% (4/87) children with short stature were diagnosed as having coeliac disease There is an overrepresentation of coeliac disease among short children admitted to hospital for examinationDiagnosis was made based on ESPGAN criteria Gold standard was applied to all children Results are not fully described
Cacciari et al (1985), Italy3108 patients (30 girls, 78 boys; age 2.8–16.7 years) with short stature (height below third centile) and no gastrointestinal symptomsProspective cohort study (level 1b/2b)Proportion of coeliac disease in study group8.3% (9/108) patients with short stature were diagnosed as having coeliac diseaseGold standard was applied to all patients Diagnosis of coeliac disease was not according to ESPGAN criteria Possible overlap in patients in the two studies of Cacciari?
Cacciari et al (1983), Italy460 children (21 girls, 39 boys) with short stature (height below third centile) and no gastrointestinal symptomsProspective cohort study (level 1b/2b)Proportion of coeliac disease in study group8.3% (5/60) patients with short stature were diagnosed as having coeliac diseaseGold standard applied to all patients Diagnosis of coeliac disease was not according to ESPGAN criteria
Rossi et al (1993), USA5117 children (age: 2–17 years) with height more than 2SD below the mean for age. Of these children, 57 were diagnosed with GH deficiency. All children were clinically and chemically euthyroidProspective cohort study (level 2b)Proportion of coeliac disease in a group of children with short stature1.7% (2/117) of children with short stature had biopsy proven coeliac disease There is an association between idiopathic short stature and coeliac diseaseBasic data are not adequately described (no sex differentiation)Gold standard was not applied to all patients Diagnosis of coeliac disease was not according to ESPGAN criteria
Bonamico et al (1992), Italy749 children (27 girls, 22 boys; mean age 112 months (SD: 39)) with short stature (height below the third centile) and no gastrointestinal symptoms. None of the 49 patients showed somatic, cardiac, renal or chromosomal disordersProspective cohort study (level 1b)Proportion of coeliac disease in the study group59.1% (29/49) children with short stature were diagnosed as having coeliac diseaseGold standard was applied to all patients Diagnosis of coeliac disease was made according to ESPGAN criteria
Groll et al (1980), UK834 children (16 girls, 18 boys; age 2.5–17.0 years) with short stature (more than 2SD below the mean for age) and no gastrointestinal symptoms. There were no dysmorphic features, and endocrine investigations were normalProspective cohort study (level 1b/2b)Proportion of coeliac disease in the study group21% (8/34) children with short stature were diagnosed as having coeliac diseaseDiagnosis was not according to ESPGAN criteria
Rosenbach et al (1986), Israel923 children (12 girls, 11 boys; age 6–16 years) below third centile for age and a bone age delay of at least 25%. Extensive preliminary work up (including hypothalamic, pituitary, adrenal, and gonadal functions, sweat test, stool examination for ova and parasites) was found to be negativeProspective cohort study (level 2b)Proportion of coeliac disease in the study group48.7% (11/23) of the patients with short stature were diagnosed as having coeliac diseaseGold standard was applied to all patients Diagnosis was not according to the ESPGAN criteria
de Lecea et al (1996), Spain10118 children (49 girls, 69 boys; age 11 months to 14 years), with height less than third centile for age. Preliminary work up (absorption, hormonal and genetic studies, sweat test, x ray for bone age, serum IgA AGA) was performedProspective cohort study (level 2b)Proportion of coeliac disease in the study group18.6% (22/118) of children with short stature had biopsy proven coeliac diseaseResults were not presented. Numbers do not add up properly.Gold standard was not applied to all children.Diagnosis was not according to ESPGAN criteria Basic data were not adequately described
Altuntas et al (1998), Turkey1147 patients (18 girls, 29 boys; age 4–16 years) of short stature (below third centile for height) without gastrointestinal tract symptoms or endocrinological, cardiac, renal or chromosomal disorders. There were no symptoms associated with coeliac disease or signs of cows’ milk allergyCross-sectional study (level 1b/2b)Proportion of coeliac disease in the study group55.3% (26/47) of the short children had biopsy proven coeliac diseaseAll children were biopsied Results are not presented clearly; the reader cannot make his own conclusions Diagnosis of coeliac disease was not according to ESPGAN criteria
Tumer et al (2001), Turkey1284 children (46 girls, 38 boys; age 16 months – 14 years) with height less than third centile for age; preliminary work-up to evaluate other causes of short stature was found to be negativeProspective cohort study (level 2b)Proportion of coeliac disease in the study groupProportion of coeliac disease was found to be 8.3% (7/84)There is an association between coeliac disease and idiopathic short statureThe IgA EmA test was not verified by a gold standard test (biopsy) in all patients Diagnosis of coeliac disease was not according to ESPGAN criteria