Coeliac patients detected during type 1 diabetes surveillance had similar issues to those diagnosed on a clinical basis

Abstract

Aim: Screening children with type 1 diabetes for coeliac disease is controversial, because they often appear asymptomatic. Our aim was to establish whether active screening should be recommended.Methods: This study focused on 22 children whose coeliac disease was detected by serological screening during diabetes surveillance and 498 children diagnosed because of a clinical suspicion. We compared the clinical and histological data at diagnosis and the children's adherence and responses to a gluten-free diet. Results:The serological screening group suffered less from decreased growth (p = 0.016) and clinical symptoms (p < 0.001) at diagnosis than the clinical group. The groups did not differ in terms of age at diagnosis (p = 0.903), gender (p = 0.353), anaemia (p = 0.886), endomysial antibody titres (p = 0.789) and the severity of small-bowel mucosal atrophy (p = 0.104). They also showed equal adherence (p = 0.086) and clinical responses (p = 0.542) to a gluten-free diet after a median follow-up of 13 months.

Estudios clínicos sobre la enfermedad celíaca (2014-2019): revisión sistemática de la prevalencia de la presentación clínica y enfermedades asociadas por edades

“…Se observó una asociación en la DM-I, tiroiditis autoinmune, síndromes de Down, Turner y Williams, déficit selectivo de IgA, alergia al polen, EII, epilepsia y familiares de primer grado. La prevalencia de enfermedades asociadas incrementa con la edad 33,34,36,37 .…”

“…El grado de atrofia vellositaria moderado-severo (Marsh III) es el más prevalente en niños y niñas, y se correlaciona con el nivel de anticuerpos ATG IgA 37,40 . Es necesario realizar un cribado serológico de celiaquía en pacientes con DM-I, a pesar de no mostrar una clínica exacerbada, porque se ha observado que al menos la mitad de los niños y niñas con DM-I en el momento del diagnóstico de la EC ya presentan atrofia vellositaria subtotal o total.…”

“…Hay que tener en cuenta que el continuo daño en la mucosa intestinal provoca excesivo consumo de medicamentos, visitas médicas reiteradas y complicaciones a largo plazo. El tratamiento de la DSG en estos pacientes con EC y DM-I concomitantes podría ayudar a mantener un equilibrio adecuado de los niveles de glucemia 37 . En el estudio realizado por Costa et al, 2016 36 , se observó la prevalencia de EC en DM-I (4,5%) y en síndrome de Down (13%), con una forma de presentación de EC clásica (32,5%), silente (5%) y potencial (62,5%).…”

Screening for coeliac disease in type 1 diabetes

“…In this issue of Acta Paediatrica, Laitinen et al (1) explore symptoms and mucosal damage in 22 patients with type 1 diabetes who were screened for coeliac disease and compared them to 498 individuals diagnosed with coeliac disease on a clinical basis. The authors concluded that screening for coeliac disease should be considered among children with type 1 diabetes, which is in line with current recommendations (2)(3)(4).…”

Type 1 Diabetes and Celiac Disease: Can (and Should) We Raise the Cut-off of Tissue Transglutaminase Immunoglobulin A to Decide Whether to Biopsy?

“…We should consider that it may not be entirely accurate to assume that most children and teenagers with T1DM and celiac disease have no or minimal symptoms: in fact, they may well have mild or under-reported symptoms, not unlike those of patients with celiac disease alone. 20 Additionally, a GFD does not seem to negatively influence the quality of life and may be beneficial to patients with T1DM and celiac disease, regardless of symptoms. 21 A study in a large series of such patients showed that those who achieved normalization of their TTG titers had better control of their glycated hemoglobin and growth.…”