SEROPREVALENCE OF COELIAC DISEASE IN SHORT STATURED CHILDREN IN SOUTH INDIA: A HOSPITAL-BASED STUDY
DOI:
https://doi.org/10.22159/ajpcr.2025v18i8.54385Keywords:
Short stature, Coeliac disease, tTG-IgA, South India, SeroprevalenceAbstract
Objective: The objective of this study was to assess the seroprevalence of coeliac disease among children with short stature in a tertiary care setting in South India.
Methods: A prospective observational study was conducted at JSS Hospital, Mysuru, from November 2018 to August 2020. Children aged 2–18 years with height <−2 standard deviation for age and sex were enrolled after informed consent. Detailed clinical evaluation, anthropometric measurements, and mid-parental height were recorded. Serum tissue transglutaminase immunoglobulin A (tTG-IgA) levels were estimated using enzyme-linked immunosorbent assay. Children with positive results (>20 U/mL) were referred for further gastroenterological evaluation. Additional tests such as hemoglobin, thyroid stimulating hormone, and bone age X-rays were done as clinically indicated.
Results: Out of 5450 children screened, 107 with short stature were included in the study. Of these, 92 (86%) had short stature and 15 (14%) had severe short stature. The most common etiology was familial short stature (43.9%), followed by idiopathic (19.6%), nutritional (15.9%), and constitutional delay in growth and puberty (11.2%). Only one child (0.9%) tested seropositive for coeliac disease. A weak but statistically significant correlation was observed between height and tTG-IgA levels (p=0.022).
Conclusion: The seroprevalence of coeliac disease in children with short stature in South India was found to be low (0.9%) compared to Northern Indian data. However, given the treatable nature of coeliac disease, screening remains crucial in the evaluation of short stature. Larger, multicentric studies with confirmatory biopsy and IgA deficiency assessment are warranted to better delineate the true prevalence in Southern India.
Downloads
References
1. Yachha SK, Poddar U. Celiac disease in India. Indian J Gastroenterol. 2007 Sep-Oct;26(5):230-7. Erratum in: Indian J Gastroenterol. 2008 Jul-Aug;27(4):158. PMID 18227574
2. Walia BN, Sidhu JK, Tandon BN, Ghai OP, Bhargava S. Coeliac disease in North Indian children. Br Med J. 1966 Nov 19;2(5524):1233-4. doi: 10.1136/bmj.2.5524.1233, PMID 5917834
3. Misra RC, Kasthuri D, Chuttani HK. Adult coeliac disease in tropics. Br Med J. 1966 Nov 19;2(5524):1230-2. doi: 10.1136/bmj.2.5524.1230, PMID 5917833
4. Kaur G, Sarkar N, Bhatnagar S, Kumar S, Rapthap CC, Bhan MK, et al. Pediatric celiac disease in India is associated with multiple DR3-DQ2 haplotypes. Hum Immunol. 2002 Aug 1;63(8):677-82. doi: 10.1016/ s0198-8859(02)00413-5, PMID 12121676
5. Agrawal S, Gupta A, Yachha SK, Müller‐Myhsok B, Mehrotra P, Agarwal SS. Association of human leucocyte‐DR and DQ antigens in coeliac disease: A family study. J Gastroenterol Hepatol. 2000 Jul;15(7):771-4. doi: 10.1046/j.1440-1746.2000.02227.x, PMID 10937683
6. Rani R, Fernandez-Viña MA, Stastny P. Associations between HLA class II alleles in a North Indian population. Tissue Antigens. 1998 Jul;52(1):37-43. doi: 10.1111/j.1399-0039.1998.tb03021.x, PMID 9714472
7. Shanmugalakshmi S, Balakrishnan K, Manoharan K, Pitchappan RM. HLA-DRB1*, -DQB1* in Piramalai Kallars and Yadhavas, two Dravidian-speaking castes of Tamil Nadu, South India. Tissue Antigens. 2003 Jun;61(6):451-64. doi: 10.1034/j.1399-0039.2003.00061.x, PMID 12823769
8. Mohindra S, Yachha SK, Srivastava A, Krishnani N, Aggarwal R, Ghoshal UC, et al. Coeliac disease in Indian children: Assessment of clinical, nutritional and pathologic characteristics. J Health Popul Nutr. 2001 Sep 1;19(3):204-8. PMID 11761775
9. Poddar U, Thapa BR, Nain CK, Prasad A, Singh K. Celiac disease in India: Are they true cases of celiac disease? J Pediatr Gastroenterol Nutr. 2002 Oct 1;35(4):508-12. doi: 10.1097/00005176-200210000- 00009, PMID 12394375
10. Patwari AK, Anand VK, Kapur G, Narayan S. Clinical and nutritional profile of children with celiac disease. Indian Pediatr. 2003 Apr;40(4):337-42. PMID 12736407
11. Sood A, Midha V, Sood N, Avasthi G, Sehgal A. Prevalence of celiac disease among school children in Punjab, North India. J Gastroenterol Hepatol. 2006 Oct;21(10):1622-5. doi: 10.1111/j.1440- 1746.2006.04281.x, PMID 16928227
12. Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology. 2001 Feb 1;120(3):636-51. doi: 10.1053/gast.2001.22123, PMID 11179241
13. Rawashdeh MO, Khalil B, Raweily E. Celiac disease in Arabs. J Pediatr Gastroenterol Nutr. 1996 Nov 1;23(4):415-8. doi: 10.1097/00005176- 199611000-00009, PMID 8956178
14. Khuffash FA, Barakat MH, Shaltout AA, Farwana SS, Adnani MS, Tungekar MF. Coeliac disease among children in Kuwait: Difficulties in diagnosis and management. Gut. 1987 Dec 1;28(12):1595-9. doi: 10.1136/gut.28.12.1595, PMID 3428686
15. Al-Hassany M. Coeliac disease in Iraqi children. J Trop Pediatr Environ Child Health. 1975 Aug 1;21(4):178-9. doi: 10.1093/tropej/21.4.178, PMID 1042173
16. Al-Bayatti SM. Etiology of chronic diarrhea. Saudi Med J. 2002 Jun 1;23(6):675-9. PMID 12070546
17. Abdullah AM. Aetiology of chronic diarrhoea in children: Experience at King Khalid University Hospital, Riyadh, Saudi Arabia. Ann Trop Paediatr. 1994 Jan 1;14(2):111-7. doi: 10.1080/02724936.1994.11747702, PMID 7521625
18. Shahbazkhani B, Malekzadeh R, Sotoudeh M, Moghadam KF, Farhadi M, Ansari R, et al. High prevalence of coeliac disease in apparently healthy Iranian blood donors. Eur J Gastroenterol Hepatol. 2003 May 1;15(5):475-8. doi: 10.1097/01.meg.0000059118.41030.96, PMID 12702902
19. Fraser JS, Woodhouse NJ, El-Shafie OT, Al-Kindy SS, Ciclitira PJ. Occult celiac disease in adult Omanis with unexplained iron deficiency anemia. Saudi Med J. 2003 Jul 1;24(7):791. PMID 12883621
20. Mazahir I, Rahman MA, Arif MA. Studies on malabsorption in malnourished Pakistani children. Z Naturforsch C J Biosci. 1988 Oct 1;43(9-10):782-6. doi: 10.1515/znc-1988-9-1024, PMID 3149828
21. Herman-Giddens ME, Bourdony CJ. Clinical assessment of growth. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020.
22. Garg P. Short stature in Indian children: Experience from a community level hospital. Sri Lanka J Child Health. 2005;34(3):84-22. doi: 10.4038/sljch.v34i3.399
23. Colaco P, Desai M, Choksi CS. Short stature in Indian children: The extent of the problem. Indian J Pediatr. 1991;58 Suppl 1:57-8. doi: 10.1007/BF02750984, PMID 1824376
24. Velayutham K, Selvan SS, Jeyabalaji RV, Balaji S. Prevalence and etiological profile of short stature among school children in a South Indian population. Indian J Endocrinol Metab. 2017 Nov;21(6):820-2. doi: 10.4103/ijem.IJEM_149_17, PMID 29285442
25. El Mouzan MI, Al Herbish AS, Al Salloum AA, Foster PJ, Al Omer AA, Qurachi MM. Prevalence of short stature in Saudi children and adolescents. Ann Saudi Med. 2011 Sep;31(5):498-501. doi: 10.4103/0256-4947.84628, PMID 21911988
26. Bhadada SK, Agrawal NK, Singh SK, Agrawal JK. Etiological profile of short stature. Indian J Pediatr. 2003 Jul 1;70(7):545-7. doi: 10.1007/ BF02723154, PMID 12940375
27. Saengkaew T, McNeil E, Jaruratanasirikul S. Etiologies of short stature in a pediatric endocrine clinic in Southern Thailand. J Pediatr Endocrinol Metab. 2017 Nov 27;30(12):1265-70. doi: 10.1515/jpem- 2017-0205, PMID 29127766
28. Christesen HT, Pedersen BT, Pournara E, Petit IO, Júlíusson PB. Short stature: Comparison of WHO and national growth standards/references for height. PLoS One. 2016 Jun 9;11(6):e0157277. doi: 10.1371/ journal.pone.0157277, PMID 27280591
29. Bhadada SK, Bhansali A, Kochhar R, Menon AS, Sinha SK, Dutta P, et al. Does every short stature child need screening for celiac disease? J Gastroenterol Hepatol. 2008 Aug;23(8 pt 2):e353-6. doi: 10.1111/j.1440-1746.2007.05261.x, PMID 18086116
30. Singh P, Sharma PK, Agnihotri A, Jyotsna VP, Das P, Gupta SD, et al. Coeliac disease in patients with short stature: A tertiary care centre experience. Natl Med J India. 2015 Jul 1;28(4):176-80. PMID 27132724
31. Dehghani SM, Asadi-Pooya AA. Celiac disease in children with short stature. Indian J Pediatr. 2008 Feb 1;75(2):131-3. doi: 10.1007/s12098- 008-0019-4, PMID 18334792
32. Giovenale D, Meazza C, Cardinale GM, Sposito M, Mastrangelo C, Messini B, et al. The prevalence of growth hormone deficiency and celiac disease in short children. Clin Med Res. 2006 Sep 1;4(3):180-3. doi: 10.3121/cmr.4.3.180, PMID 16988097
33. Queiroz MS, Nery M, Cançado EL, Gianella-Neto D, Liberman B. Prevalence of celiac disease in Brazilian children of short stature. Braz J Med Biol Res. 2004 Jan;37(1):55-60. doi: 10.1590/s0100- 879x2004000100008, PMID 14689044
34. Mäki M, Mustalahti K, Kokkonen J, Kulmala P, Haapalahti M, Karttunen T, et al. Prevalence of celiac disease among children in Finland. N Engl J Med. 2003 Jun 19;348(25):2517-24. doi: 10.1056/ NEJMoa021687, PMID 12815137
35. Bonamico M, Sciré G, Mariani P, Pasquino AM, Triglione P, Scaccia S, et al. Short stature as the primary manifestation of monosymptomatic celiac disease. J Pediatr Gastroenterol Nutr. 1992 Jan 1;14(1):12-6. doi: 10.1097/00005176-199201000-00003, PMID 1573504
36. Ahmad F, Alam S, Shukla I, Sherwani R, Ali SM. Screening children with severe short stature for celiac disease using tissue transglutaminase. Indian J Pediatr. 2010 Apr 1;77(4):387-90. doi: 10.1007/s12098-010- 0040-2, PMID 20422329
37. Ramakrishna BS, Makharia GK, Chetri K, Dutta S, Mathur P, Ahuja V, et al. Prevalence of adult celiac disease in India: Regional variations and associations. Am J Gastroenterol. 2016 Jan 1;111(1):115-23. doi: 10.1038/ajg.2015.398, PMID 26729543
38. Shiva S, Nikzad A. Etiology of short stature in East Azerbaijan, Iran. J Pediatr. 2009;19(1):35-40.
39. Al-Jurayyan NA, Al Nemri AM, Al Jurayyan AN, Assiri AM. Celiac disease in children with short stature: A hospital based study. J Taibah Univ Med Sci. 2013 Aug 1;8(2):93-6. doi: 10.1016/j. jtumed.2013.03.003
40. Moayeri H, Aghighi Y. A prospective study of etiology of short stature in 426 short children and adolescents. Arch Iran Med. 2004;7(1):23-7.
Published
How to Cite
Issue
Section
Copyright (c) 2025 Vasanth Perumal, Uma Gayathri Bagavathi Perumal, Syed mohammed Hassan Ali, Manjunath V.G

This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.