Screening of celiac disease in children and adolescents with type 1 diabetes mellitus

Abstract

Background and aim: Celiac disease is the most frequent autoimmune disease in Type 1 diabetes mellitus. We aimed to determine the celiac disease prevalence in patients with type 1 diabetes mellitus, additionally to evaluate the clinical, serological and molecular characteristics of type 1 diabetes mellitus and celiac disease which have a common genetic predisposition. Material and methods: A total number of 76 type 1 diabetes mellitus patients aged between 1-18 years, were evaluated retrospectively. Serologic screening for celiac disease was performed via anti-tissue transglutaminase and anti-endomysial antibodies. Presence of human leukocyte antigens (HLA) (DQ2 and DQ8) documented as well. Patients with positive tissue transglutaminase and endomysial antibodies underwent endoscopic biopsy. Histopathological analysis were performed according to the modified Marsh classification. Patients' demographic characteristics, anthropometric measurements, physical examination, laboratory findings, age at type 1 diabetes mellitus and celiac disease onset, and celiac disease prevalence were evaluated. In addition all findings were compared between type 1 diabetes mellitus patients and newly diagnosed celiac disease patients. Results: Serum tissue transglutaminase was positive in 14,5% (n=11) of all patients and serum endomysial antibodies was positive in 13,2% (n=10). The overall prevalence of celiac disease in type 1 diabetes mellitus was confirmed as 10.5% (n=8) by histopathological examination in present study. Of the celiac disease patients 37.5% were asymptomatic. In addition, 6 were anti-tissue transglutaminase and 7 were endomysial antibodies positive. Moreover, 60.3% (n=41) were HLADQ2 and 58.8% (n=40) were HLA-DQ8 positive. Selective IgA deficiency was described in 3 cases. In one of them HLA-DQ2/HLA-DQ8 was found positive and celiac disease diagnosis was confirmed by biopsy. HLA-DQ8 ratio was found significantly higher in patients with celiac disease than the type 1 diabetes mellitus patients. In addition, HLA-DQ2/DQ8 positivity was observed in 62.5% (n=5) of celiac disease patients. Conclusion: Our findings have demonstrated the increasing prevalence of celiac disease in children with type 1 diabetes mellitus. Particularly the higher risk of asymptomatic celiac disease in type 1 diabetes mellitus patients, revealed the diagnostic value of serological screening. Furthermore, increased HLA-DQ2 and HLA-DQ8 positivity, which are more prominent in case of selective IgA deficiency, clearly demonstrates the requirement of routine total IgA and HLA analysis in serological screening.