Gluten-dependent diabetes-related and thyroid-related autoantibodies in patients with celiac disease

AIMS/HYPOTHESIS: We tested the hypothesis that silent coeliac disease is more frequent than expected in both patients with Type I (insulin-dependent) diabetes mellitus and their first-degree relatives. We evaluated how the presence of other autoimmune disorders in diabetic patients and their first-degree relatives is related to silent, unrecognized coeliac disease. METHODS: Sera from 491 subjects with Type I diabetes, 824 relatives and 4,000 healthy control subjects were screened for anti-endomysial antibodies and all those subjects who tested positive for anti-endomysial antibodies underwent intestinal biopsy. RESULTS: We found that the prevalence of coeliac disease was 5.7 \% among the diabetic patients and 1.9 \% among the relatives, values significantly higher than those found among the control subjects (p < 0.0001; p < 0.001). The prevalence of autoimmune disorders in diabetic patients with coeliac disease was significantly higher than in subjects with Type I diabetes alone (p < 0.0001). The prevalence of autoimmune disorders in the relatives with coeliac disease was significantly higher than in those who tested negative for anti-endomysial antibodies (p = 0.01). CONCLUSION/INTERPRETATION: This report provides further confirmation of the high prevalence of undiagnosed coeliac disease among diabetic patients and their relatives. This interesting new finding is the increased presence of other autoimmune diseases in these patients, as well as in their relatives with a delayed diagnosis for coeliac disease. Patients newly diagnosed with coeliac disease showed excellent compliance with the gluten-free diet. This should encourage policymakers to consider introducing an easy-to-use screening programme for diabetic patients and their relatives into everyday clinical practice, in order to prevent coeliac-associated symptoms and the onset of additional, more serious auto-immune disorders

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“…It cannot therefore be ruled out that in these subjects, the humoral expression of specific autoimmunity was affected by gluten exposure [29,30].…”

Section: Discussionmentioning

confidence: 99%

Undiagnosed coeliac disease and risk of autoimmune disorders in subjects with Type I diabetes mellitus

et al. 2001

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“…A recent study (35) of 909 celiac patients 12-20 years of age showed that the prevalence of various conditions, including type 1 diabetes, dermatitis herpetiformis, epilepsy with cerebral calcifications, Hashimoto's disease, alopecia, Addison's disease, and gastritis, was considerably higher in those diagnosed with celiac disease after 10 years of age than in those diagnosed before age 10 years. The authors speculate (35,36) that continuing exposure to gluten may facilitate development or progression of autoimmune diseases other than celiac disease. However, anecdotal reports (37,38) notwithstanding, there is no conclusive evidence that gluten restriction alters the clinical course or outcome of other established autoimmune diseases (39 -41).…”

Section: Freemark and Levitskymentioning

confidence: 99%

Screening for Celiac Disease in Children With Type 1 Diabetes

2003

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“…Particularly, it has been suggested that untreated (latent or silent) CD could be an immunological trigger and induce diabetes and/or thyroid disorders due to gluten as a driving antigen (Pocecco & Ventura, 1995). In accordance with this, the prevalence of autoimmune disorders in CD is closely related to age at diagnosis or, in other words, to the duration of exposure to gluten (Ventura et al, 1999) and thyroid-related antibodies tend to disappear during twelve months of gluten-free diet, like CD-related antibodies (Ventura et al, 2000). However, at present, it is unknown whether treatment of CD reduces the likelihood of developing autoimmune disorders, or changes their natural history and actually others found no correlation between duration of gluten exposure in adult CD and risk of autoimmune disorders (Viljamaa et al, 2005).…”

Section: Type 1 Diabetes and Celiac Disease 221 Prevalence And Age mentioning

confidence: 57%

“…Non-gastrointestinal or atypical symptoms of CD include short stature, pubertal delay, fatigue, vitamin deficiencies, and iron deficiency anemia and are more commonly observed in older children. The classical presentation of CD can occur in T1D patients, but many patients with CD and T1D are either asymptomatic (silent CD) or present with only mild symptoms (Holmes, 2001a;Ventura et al, 2000). Diagnosis of CD is regularly performed because screening protocols are universally recommended and performed.…”

Section: Clinical Features and Follow Upmentioning

confidence: 99%