title: High prevalence of celiac disease in patients with type 1 diabetes detected by antibodies to endomysium and tissue transglutaminase.
abstract: OBJECTIVE
  To establish the prevalence of celiac disease (CD) in children with type 1 diabetes in British Columbia.
  
  
  METHODS
  Two hundred thirty-three children with type 1 diabetes were prospectively screened for CD using blind testing with the current 'gold standard', immunoglobulin A endomysium antibody (EmA), and the novel immunoglobulin A tissue transglutaminase (tTG) antibody. Those children with positive results were offered small bowel biopsy; a gluten-free diet was recommended if CD was confirmed.
  
  
  RESULTS
  Nineteen children were positive for EmA and had an elevated tTG level. One patient from this group was already known to have CD, and the other 18 patients consented to biopsy. One biopsy was normal, three biopsies demonstrated elevated intraepithelial lymphocyte counts with normal morphology and 14 biopsies had morphological changes consistent with CD. Growth parameters were normal in all patients, and nine of 19 children who were positive for EmA were asymptomatic. Seven patients had mild elevation of tTG levels alone. Two children from this latter group had normal biopsies, and five declined biopsy.
  
  
  CONCLUSIONS
  At least 14 new cases of CD were detected in addition to four known cases, yielding an overall biopsy-confirmed prevalence of CD of 7.7% (18 of 233). The present study confirms that CD is as prevalent in the pediatric type 1 diabetic population in British Columbia as it is in Europe. Serological screening of these children is important because many children have no symptoms or signs suggestive of CD. This study suggests that tTG serology may also be useful in monitoring response and compliance with a gluten-free diet.
authors.affiliation: British Columbia's Children's Hospital, Vancouver, Canada.
authors.forename: P M
authors.initials: PM
authors.lastname: Gillett
authors.forename: H R
authors.initials: HR
authors.lastname: Gillett
authors.forename: D M
authors.initials: DM
authors.lastname: Israel
authors.forename: D L
authors.initials: DL
authors.lastname: Metzger
authors.forename: L
authors.initials: L
authors.lastname: Stewart
authors.forename: J P
authors.initials: JP
authors.lastname: Chanoine
authors.forename: H J
authors.initials: HJ
authors.lastname: Freeman
mesh_terms: D000293:Adolescent; D001706:Biopsy; D001955:British Columbia / Q000453:epidemiology; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006776:Hospitals, Pediatric; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D008297:Male; D008403:Mass Screening / Q000379:methods; D018485:Muscle Fibers, Skeletal / Q000276:immunology*; D015995:Prevalence; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012698:Serologic Tests / Q000379:methods; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins