Prevalence of coeliac disease and longitudinal follow-up of antigliadin antibody status in children and adolescents with type 1 diabetes mellitus.
Coeliac disease (CD) is more prevalent in individuals with type 1 diabetes mellitus (DM), and when untreated is associated with a number of medical complications, including poor glycaemic control. Identification of patients with CD has been facilitated in recent years by serological screening, including the use of antigliadin antibodies (AGAs) and endomysial antibodies (EMAs). The aim of this study was to assess the prevalence of CD in a clinic-based paediatric population with type 1 DM, and to study longitudinal changes in AGA status. Two-hundred-and-eighty-one children and adolescents with type 1 DM aged 9.9 +/- 3.8 yr were screened using AGAs of immunoglobulin A (IgA) and immunoglobulin G (IgG) classes (AGA-IgA and AGA-IgG). Thirty-five patients had both antibodies positive and underwent gastro-duodenoscopy and multiple biopsies. Fifteen of the 35 patients had histological evidence of CD, and the overall clinic prevalence of CD was 5.7%. A number of patients did not exhibit florid symptoms, and recurrent unexplained hypoglycaemia was a significant finding. Patients who perceived themselves to be asymptomatic had more problems with compliance with a gluten-free diet (GFD). Ninety-seven patients had follow-up AGAs performed after 2.5 +/- 1.5 yr. One patient with initially normal AGAs developed positive antibodies and histological findings of CD. Antibody status has fluctuated in other patients. CD is common in patients with DM, and diagnosis is important to detect to minimize long-term morbidity related to both disorders. Initial normal screening does not exclude CD and repeat screening is indicated.
Smith
C M
CM
Children's Program, Monash Medical Center, Clayton, Victoria, Australia.
Clarke
C F
CF
Porteous
L E
LE
Elsori
H
H
Cameron
D J
DJ