title: [Prognostic factors of celiac disease occurrence in type 1 diabetes mellitus children].
abstract: BACKGROUND
  Discussion on the frequency of coexistent celiac disease and type 1 diabetes mellitus (DM1) as well as an attempt to standardize diagnostic methods of celiac disease detection among DM1 children have been performed.
  
  
  OBJECTIVE
  To assess the incidence of celiac disease among DM1 children in the Pomeranian region of Poland followed by analysis of the putative prognostic factors for celiac disease development in this particular group of children.
  
  
  METHODS
  70 children aged 9.47+/-4.59 (group 1) de novo diagnosed with DM1 and 223 children aged 10.20+/-3.87 with long-standing diabetes mellitus type 1 (4.47+/-3.16 years from the diagnosis) were enrolled in the study. All the patients had C-peptide, HbA1c, CRP, TSH, fT4, fT3, urinary albumin secretion rate, IgA, level of antigliadin antibodies (AGA), anti-tissue transglutaminase (TGA) IgA and IgG antibodies (ELISA), anti-endomysium (EmA) IgA and IgG antibodies (immunofluorescence) and anti-tyreoglobulin antibodies (TG), anti-thyroid peroxidase (TPO) antibodies (ELISA) evaluated. All the patients had jejunal biopsy and thyroid ultrasound examination.
  
  
  RESULTS
  5.7% of group 1 patients were diagnosed with celiac disease based on the positive jejunal biopsy in comparison with 9.4% in the group 2. TGA antibodies were present in 9.52% of group 2, AGA in 7.62%, EmA in 6.19%. 10% of group 1 children had autoimmune thyroiditis versus 24.2% of group 2 children. The group of children with coincident long-lasting DM1 and celiac disease (group A) was characterized by significantly earlier age at diagnosis (p=0.003), higher HbA(1)c (p=<0.001), CRP (p<0.001) and elevated urine albumin secretion in relation to children without celiac disease and autoimmune thyroiditis (group B). Serologic test detecting TGA antibodies was found to be the most sensitive (95.2%) for the detection of celiac disease among DM1 children, while the lowest sensitivity was obtained in the case of the EmA antibody test (61.9%).
  
  
  CONCLUSIONS
  The celiac disease morbidity confirmed by jejunal biopsy is high among DM1 children (9.4%). The assessment of the serum TGA appears to be the most sensitive screening marker for the celiac disease detection in DM1 children.
authors.affiliation: Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii AM w Gdańsku, Gdańsk. mysliwiec@amg.gda.pl
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Myśliwiec
authors.forename: Anna
authors.initials: A
authors.lastname: Balcerska
authors.forename: Jan
authors.initials: J
authors.lastname: Stepiński
authors.forename: Alicja
authors.initials: A
authors.lastname: Bakowska
authors.forename: Anna
authors.initials: A
authors.lastname: Jedrzejczyk
authors.forename: Joanna
authors.initials: J
authors.lastname: Bautembach-Minkowska
authors.forename: Beata
authors.initials: B
authors.lastname: Sztangierska
authors.forename: Piotr
authors.initials: P
authors.lastname: Banach
authors.forename: Piotr
authors.initials: P
authors.lastname: Wiśniewski
mesh_terms: D000293:Adolescent; D001327:Autoimmune Diseases / Q000175:diagnosis; D001685:Biological Factors; D002446:Celiac Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology; D005260:Female; D005903:Gliadin / Q000276:immunology*; D006801:Humans; D008297:Male; D011044:Poland; D015995:Prevalence; D011379:Prognosis; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D001685:Biological Factors; D005903:Gliadin; D011503:Transglutaminases