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Anthropometric, serologic, and laboratory correlation with villous blunting in pediatric celiac disease: diabetics
Muralidhar Jatla1, Aqiba Bokhari, Patricia Bierly
1Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia (CHOP), University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Insights
In children with celiac disease (CD), higher tissue transglutaminase (TTG) and endomysial antibody (EMA) levels correlate with severe intestinal damage. Celiac disease in type 1 diabetes patients is often silent and shows identical serologic findings.
Area of Science:
- Pediatric Gastroenterology
- Endocrinology
- Immunology
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Type 1 diabetes (DM) is an autoimmune condition often co-occurring with CD.
- Assessing the relationship between CD severity and co-existing DM is crucial for patient management.
Purpose of the Study:
- To evaluate the correlation between antibody levels (TTG, EMA) and intestinal damage (Marsh classification) in children with and without type 1 diabetes.
- To assess correlations between clinical and laboratory markers (albumin, hemoglobin, transaminases, BMI, symptoms, age of cereal introduction) and intestinal damage in these children.
Main Methods:
- Retrospective review of 60 children diagnosed with CD via duodenal biopsies.
- Patients were categorized based on Marsh classification for histologic damage.
- Comparison between children with (DM+) and without (DM-) type 1 diabetes.
Main Results:
- Higher median TTG and EMA levels were observed in children with severe Marsh III enteropathy (MIIIa-c) compared to milder forms.
- No significant differences in Marsh classification were found between DM- and DM+ groups.
- In DM- children, lower BMI percentile, hemoglobin, and mean corpuscular volume correlated with advancing histology; this correlation was not significant in DM+ children.
Conclusions:
- Elevated TTG and EMA serum values indicate more severe enteropathy in pediatric celiac disease.
- Celiac disease in children with type 1 diabetes presents with similar serologic and histologic features as in non-diabetic children.
- Screening for CD in type 1 diabetes patients often reveals silent cases, lacking typical symptoms, growth issues, or anemia, making clinical parameters unreliable for detection.
Objectives:
We evaluated the correlation between level of tissue transglutaminase (TTG) and endomysial antibodies (EMAs) to different degrees of intestinal damage in celiac disease (CD) children with [presence of diabetes mellitus (DM)+] and without [absence of diabetes mellitus (DM-)] type I diabetes. We also assessed the correlation between albumin, hemoglobin (hgb), transaminases, symptom presence, age of cereal introduction, and body mass index (BMI) to different degrees of intestinal damage.
Methods:
Retrospective review of patients seen at the Children's Hospital of Philadelphia between January 2002 and June 2006 revealed 60 children (mean age 9.8 y) who had TTG, EMA, and other laboratory tests performed at time of histologic CD diagnosis from duodenal biopsies. Twenty-one of 60 children had DM. All children were stratified for histologic damage according to Marsh classification.
Results:
Overall, Marsh (M) I lesions were seen in 2 (3.3%), MII in 2 (3.3%), IIIa in 14 (23.3%), IIIb in 15 (25%), and IIIc in 27 (45%); no differences in DM- versus DM+ groups. TTG was positive in all and EMA was positive in all but 1 child. Among DM- and DM+ children, median TTG and EMA values were higher with MIIIa-c, respectively. For DM-, BMI percentile, hgb, and mean corpuscular volume were lower with advancing histology. However, in DM+, no significant correlation of BMI percentile, hgb, or mean corpuscular volume with grade was observed. Cereal introduction age, hypoalbuminemia, and hepatitis did not differ between MIIIa-c in any group.
Conclusions:
TTG and EMA mean serum values are higher in CD children with severe enteropathy (MIIIc) than in those with mild enteropathy (MIIIa). CD in DM is accompanied by serologic and histologic findings identical to that of a non-DM CD population. As CD is identified through screening in DM, it is often silent and not associated with symptoms, growth abnormalities, or anemia. Clinical parameters (height, weight, hgb, symptoms) are not helpful in identifying silent CD in DM.
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