Screening by anti-endomysium antibody for celiac disease in diabetic children and adolescents in Austria.
BACKGROUND
Unrecognized celiac disease (CD) may be found in a substantial proportion of patients with type I diabetes mellitus.


METHODS
A cohort of 403 Austrian children and adolescents with type I diabetes mellitus (210 males and 193 females; age range, 1-22 years) was screened for celiac disease using the IgA anti-endomysium antibody test (EMA) and the immunoglobulin (Ig)G anti-gliadin (AGA-IgG) and IgA anti-gliadin (AGA-IgA) antibody test.


RESULTS
Twelve patients' sera (2.98%) yielded positive EMA results and two patients' sera (0.49%) with IgA deficiency had high AGA-IgG values. All but one of these patients underwent intestinal biopsy. Six (1.49%) had clear histologic evidence of CD (flat mucosa), whereas three (0.74%) showed minor histologic changes (increase in intraepithelial lymphocytes) and four (0.99%), including the EMA-negative patients with IgA deficiency, had a normal mucosa. When the cases with silent and potential CD were combined, the overall prevalence in the current cohort was 2.98%. There was no difference in the hemoglobin (Hb)A1c level between antibody-positive and -negative patients, and subsequent gluten-free diet did not change this metabolic parameter.


CONCLUSIONS
The prevalence of clinically unrecognized CD, found by EMA screening, is much higher in Austrian children with diabetes than in a comparable population without diabetes. The prevalence of CD in diabetic children in Austria is distinctly lower, however, than in several other countries.
Schober
E
E
Department of Pediatrics, University of Vienna, Austria.
Bittmann
B
B
Granditsch
G
G
Huber
W D
WD
Hüppe
A
A
Jäger
A
A
Oberhuber
G
G
Rami
B
B
Reichel
G
G
D000293:Adolescent; D000328:Adult; D001317:Austria / Q000453:epidemiology; D001323:Autoantibodies / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D005903:Gliadin / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000379:methods; D018485:Muscle Fibers, Skeletal / Q000276:immunology*; D015995:Prevalence
D001323:Autoantibodies; D015415:Biomarkers; D007074:Immunoglobulin G; D005903:Gliadin