Abstract
BackgroundThere is lack of data on prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) in Arabs in the Middle East. The present investigation aims to study the prevalence rate and clinical characteristics of CD among Saudi children with T1D using a combination of the most sensitive and specific screening serologic tests (anti- tissue transglutaminase antibodies IgA [anti-TTG] and ednomyseal antibodies [EMA]) and to determine the lower cut-off value of anti- anti-TTG level that best predicts CD in children with T1D.MethodsChildren with T1D following in diabetic clinic have been prospectively screened for presence of CD, over a two-year period (2008–2010), by doing anti-TTG, EMA, and total IgA. Children with positive anti-TTG titres (>50 U/ml) and/or EMA and children with persistently low positive anti-TTG titres (two readings 20–50 U/ml; within 6 months intervals) had upper endoscopy and 6 duodenal biopsies.ResultsOne hundred and six children with T1D have been screened for CD: age ranged between 8 months to 15.5 years (62 females). Nineteen children had positive anti-TTG and/or EMA, however only 12 children had biopsy proven CD (11.3%). Five of 12 had gastrointestinal symptoms (42%). Children with T1D and CD had significantly lower serum iron than children with T1D alone (8.5 μgm/L Vs 12.5 μgm/L; P = 0.014). The sensitivity and specificity of anti-TTG were 91.6% and 93.6%, with a positive and negative predictive value of 64.7% and 98.8%, respectively. Receiver operated characteristics analysis for the best cut-off value of anti-TTG level for diagnosis of CD was 63 units (sensitivity 100% and specificity 98.8%).ConclusionCD is highly prevalent among Saudi children with T1D. Anti-TTG titres more than 3 times the upper limit of normal has very high sensitivity and specificity for diagnosis of CD in T1D children.
Highlights
There is lack of data on prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) in Arabs in the Middle East
There is a limited data on prevalence of CD in children with T1D in Arabs in Middle East
Serologic screening Of 106 children with T1D, 26 (24.5%) were positive for anti-TTG and / or endomyseal antibody (EMA) (Figure 1)
Summary
There is lack of data on prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) in Arabs in the Middle East. In the last two decades, increased CD prevalence (1–16%) in patients with type 1 diabetes mellitus (T1D) has been well documented in numerous screening studies made all over the world [1,2,3,4,5]. There is a limited data on prevalence of CD in children with T1D in Arabs in Middle East. Anti-gliadin antibodies-based screening study in Riyadh, the capital city of Saudi Arabia, revealed a 4.9% prevalence of CD in T1D children [8]. Anti-tissue transglutaminase (anti-TTG) antibodies based, screening study, the prevalence of CD among T1D children in Western region of Saudi Arabia was 11.2% [10]
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