Prevalence of Celiac Disease in Children with Type 1 Diabetes Mellitus in the South of Turkey

Abstract

Background: Type 1 Diabetes Mellitus (DM), autoimmune disorders, relatives of celiac patients have higher risk of developing celiac disease (CD) because they share the same HLA type. Celiac disease and type 1 DM are autoimmune and common in children. According to international guidelines, serological screening for CD in children and adults with type 1 DM is recommended but there is no consensus on how often it will be performed. Objectives: We aimed to investigate the prevalence of CD in children with type 1 diabetes mellitus (DM). Methods: This current study was carried out between 01 March 2017 and 15 December 2018. 273 children with type 1 DM were included in the study. Tissue transglutaminase antibody IgA (tTG IgA) and total IgA levels were measured in all patients. The patients with tTG IgA positivity underwent gastroduodenoscopy. Results:Of the 273 patients (139 girls), the mean age was 11.61 ± 3.73 years. tTG IgA was positive in 23 patients, and 2 of them refused the process of endoscopy. Gastroduodenoscopy was performed on other patients. 11 patients with Marsh 3, 2 patients with Marsh 2, 4 patients with Marsh 1, and 4 patients with Marsh 0 were detected in the present study. In other words, 12 patients were diagnosed with CD. Nine of 12 patients diagnosed with CD were diagnosed within the first 5 years after the diagnosis of type 1 DM. Conclusions:We found that the prevalence of biopsy-proven CD in children with type 1 DM was 4.4%, which was approximately 9 times higher than the prevalence of CD in the general population. In the current study, 9 of 12 patients diagnosed with CD were diagnosed within the first 5 years after DM. According to our results, we recommend that screening tests for CD should be performed at least once a year for 5 years in children with Type 1 DM, even if the patients are asymptomatic.

Celiac disease in children: A review of the literature

“…In a systematic review, the prevalence of celiac disease in patients with type 1 DM was reported to be approximately six times higher than in the general population[ 91 ]. The prevalence of celiac disease was reported to be 2.4%-16.4% in children with type 1 DM[ 92 - 95 ]. There is consensus about initial screening for celiac disease in newly diagnosed DM patients, but it is not clear when and how often to screen for celiac disease and initiate a gluten-free diet in asymptomatic patients[ 93 ].…”

“…It has been recommended that screening test for CD should be done at the time of type 1 DM diagnosis and then every 2 years[ 96 ]. In another study, it was recommended that children diagnosed with type 1 DM should be screened for celiac disease once a year for the first 5 years[ 92 ]. In other studies, it has been recommended that serological screening tests for celiac disease should be done within the first 2 years when the diagnosis is made, then 5 years after the diagnosis and if there is any symptom suggestive of CD[ 93 , 97 ].…”

“…In other studies, it has been recommended that serological screening tests for celiac disease should be done within the first 2 years when the diagnosis is made, then 5 years after the diagnosis and if there is any symptom suggestive of CD[ 93 , 97 ]. Since 58%-85% of type 1 DM patients diagnosed with CD are asymptomatic, early diagnosis of CD is very important to prevent long-term complications such as failure to thrive, osteopenia, infertility, and malignancy[ 29 , 77 , 92 , 93 , 98 , 99 ].…”

The prevalence of celiac disease in Saudi patients with type 1 diabetes mellitus

“…11 Internationally, the prevalence ranges from 3%-12%. [12][13][14] There are multiple possible reasons for the low prevalence of confirmed CD in this study, including early screening of asymptomatic T1DM patients, the low referral rate for endoscopy by the treating physician, patient or family refusal to undergo an endoscopy, and loss of patient follow-up at the gastroenterology service.…”

Clinical evaluation of children with celiac disease: A single-center experience

“…The risk of developing CD is higher in type 1 Diabetes Mellitus (DM), Down syndrome, Turner syndrome, autoimmune disorders, and relatives of celiac patients sharing the same type of HLA [3][4][5][6].…”