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General screening for celiac disease is advisable in children with type 1 diabetes
U Spiekerkoetter1, J Seissler, U Wendel
1Heinrich-Heine University Hospital, Department of Pediatrics, Düsseldorf, Germany. ute.spiekerkoetter@mcmail.vanderbilt.edu
Insights
Screening for celiac disease (CD) using tissue transglutaminase autoantibodies (tTGA) in children with type 1 diabetes is feasible. This approach identifies both symptomatic and asymptomatic CD cases, enabling early intervention to prevent complications.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Immunology
Background:
- Type 1 diabetes and celiac disease share a known association.
- Celiac disease diagnosis in children often relies on typical symptoms, with many cases remaining undiagnosed.
- Screening diabetic children for celiac disease may improve early detection rates.
Purpose of the Study:
- To assess the feasibility of screening for celiac disease in children diagnosed with type 1 diabetes.
- To determine the prevalence of celiac disease markers in this pediatric population.
- To evaluate the clinical presentation and histological confirmation of celiac disease in diabetic children.
Main Methods:
- A 12-month screening of 205 children with type 1 diabetes for tissue transglutaminase autoantibodies (tTGA).
- Clinical evaluation and duodenal biopsy for tTGA-positive cases to confirm celiac disease.
- Histological grading of duodenal inflammation using the Marsh classification.
Main Results:
- 13 out of 205 children (6.3%) tested positive for tTGA.
- Celiac disease was histologically confirmed in 7 of 8 children who underwent biopsy (Marsh 1: n=1, Marsh 3: n=6).
- Confirmed celiac disease cases included latent (symptomatic) and silent (asymptomatic) forms, highlighting mild or absent symptoms despite inflammation.
Conclusions:
- Tissue transglutaminase autoantibody screening is a feasible strategy for identifying celiac disease in children with type 1 diabetes.
- This screening approach can detect both symptomatic and asymptomatic celiac disease, including latent and silent forms.
- Early detection through tTGA screening in diabetic children is recommended for preventing long-term complications associated with celiac disease.
Abstract:
The association between celiac disease (CD) and diabetes mellitus type 1 is well known. Only about one-third of all patients with CD are diagnosed in childhood as a result of typical gastrointestinal symptoms or growth retardation. To evaluate the feasibility of CD screening in diabetic children, we tested autoantibodies to tissue transglutaminase (tTGA) in all children with type 1 diabetes from our pediatric department during a 12-month period. In antibody-positive cases, we analyzed the clinical presentation and offered a duodenal biopsy to confirm the diagnosis and grade the severity of the inflammatory process. Of 205 children, 13 (6.3 %) were tTGA-positive. In seven of eight children who agreed to perform a biopsy, CD typical histological signs were detected (Marsh 1: n = 1, Marsh 3: n = 6). In three patients with confirmed disease, symptoms (iron deficiency, recurrent abdominal pain) remained undiscovered up to time of screening (latent form); in four, the disease was asymptomatic (silent form). Since clinical symptoms are mostly mild or absent in spite of severe signs of duodenal inflammation, we recommend tTGA screening in all diabetic children. This strategy may allow the identification of patients in an early stage in respect of prevention of long-term complications.