title: Screening by anti-endomysium antibodies for celiac disease in Tunisian children with type 1 diabetes mellitus.
abstract: OBJECTIVE
  Celiac disease (CD) and type 1 diabetes mellitus (DM1) can frequently coexist, presumably due to a common genetic predisposition. The present study was designed to evaluate the frequency of CD among Tunisian children with DM1.
  
  
  METHODS
  A total of 205 diabetic children (92 girls, 113 boys, age range 6 months-15 years, median 11 years) were screened for CD by determination of IgA anti-endomysium antibodies (EMA).
  
  
  RESULTS
  EMA were positive in 17 out of 205 (8.3%) children with DM1. The median age of DM1 at onset was significantly lower in patients with EMA than those without EMA (P<10(-7)). In 13 of 17 EMA-positive patients, duodenal biopsy could be performed and a destructive type of CD was confirmed in 11 of them: 8 patients showed total villous atrophy, 3 patients showed a partial villous atrophy. The other two patients showed a normal histological picture with normal number of intraepithelial lymphocytes. Parents of the remaining EMA-positive children refused endoscopy. Thus the prevalence of biopsy-proven CD was 5.3% (11/205). It was 7.6% (7/92) in girls and 3.5% (4/113) in boys but the difference was not statistically significant. Seventy three percent of patients with CD were asymptomatic.
  
  
  CONCLUSIONS
  The prevalence of clinically unrecognized CD, found by EMA screening, is high in Tunisian children with DM1. We suggest that children with diabetes should be screened for CD.
authors.affiliation: Department of Immunology, Research Unit, Faculty of Pharmacy, Monastir, Tunisia.
authors.forename: Amani
authors.initials: A
authors.lastname: Mankaï
authors.forename: Hechmi
authors.initials: H
authors.lastname: Ben Hamouda
authors.forename: Fethi
authors.initials: F
authors.lastname: Amri
authors.forename: Leila
authors.initials: L
authors.lastname: Ghedira-Besbes
authors.forename: Abdelaziz
authors.initials: A
authors.lastname: Harbi
authors.forename: Mohamed
authors.initials: M
authors.lastname: Tahar Sfar
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sahloul Essoussi
authors.forename: Moncef
authors.initials: M
authors.lastname: Jeddi
authors.forename: Ibtissem
authors.initials: I
authors.lastname: Ghedira
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001284:Atrophy; D001323:Autoantibodies / Q000097:blood*; D001706:Biopsy; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D004386:Duodenum / Q000473:pathology; D005260:Female; D019793:Fluorescein; D019084:Fluorescent Antibody Technique, Indirect; D005456:Fluorescent Dyes; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007223:Infant; D007413:Intestinal Mucosa / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008403:Mass Screening; D018485:Muscle Fibers, Skeletal / Q000276:immunology*; D011446:Prospective Studies; D014416:Tunisia
chemical_list: D001323:Autoantibodies; D005456:Fluorescent Dyes; D007070:Immunoglobulin A; D019793:Fluorescein