Use of immunoglobulin A-antiendomysial antibody to screen for celiac disease in North American children with type 1 diabetes.
OBJECTIVE
Our objective was to determine if a serological marker, the immunoglobulin A antiendomysial antibody (IgA-EMA), can be used to screen for celiac disease in North American children with type 1 diabetes.


METHODS
Subjects included 236 diabetes clinic patients and 56 gastrointestinal clinic patients who underwent intestinal biopsy for suspected malabsorption. Total IgA and IgA-EMA assays were performed. Diabetic patients who were positive for IgA-EMA were asked to undergo biopsy.


RESULTS
Of 236 diabetic patients tested, none were IgA deficient and 19 were positive for IgA-EMA (8%). Of 17 patients biopsied, 12 had celiac disease and 3 were symptomatic. The estimated prevalence of celiac disease was 5.1%, consistent with data from European diabetic clinics. Of the 56 gastrointestinal clinic patients, the 3 who were IgA-EMA positive had biopsies diagnostic of celiac disease. Three were found to be IgA deficient, one of whom had celiac disease. Of the 50 IgA-sufficient and IgA-EMA-negative patients, 1 had celiac disease and 49 did not. The IgA-EMA test had a sensitivity of 94% and a specificity of 91% for IgA-sufficient biopsied patients.


CONCLUSIONS
IgA-EMA is an appropriate tool for demonstrating an increased prevalence of celiac disease in a North American pediatric diabetic population. Positive testing should be confirmed by intestinal biopsy, and false-positive results require serial follow-up. Symptomatic children require biopsy regardless of their IgA-EMA status.
Fraser-Reynolds
K A
KA
Department of Pediatrics, Alberta Children's Hospital, Faculty of Medicine, University of Calgary, Canada.
Butzner
J D
JD
Stephure
D K
DK
Trussell
R A
RA
Scott
R B
RB
D000293:Adolescent; D000888:Antibodies, Anti-Idiotypic / Q000032:analysis*; D001323:Autoantibodies / Q000032:analysis*; D015415:Biomarkers; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000276:immunology*; D007223:Infant; D007422:Intestines / Q000276:immunology / Q000473:pathology; D008297:Male; D008403:Mass Screening; D009656:North America / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies
D000888:Antibodies, Anti-Idiotypic; D001323:Autoantibodies; D015415:Biomarkers; D007070:Immunoglobulin A