Screening by anti-endomysium antibodies for celiac disease in Tunisian children with type 1 diabetes mellitus.
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.
Mankaï
Amani
A
Department of Immunology, Research Unit, Faculty of Pharmacy, Monastir, Tunisia.
Ben Hamouda
Hechmi
H
Amri
Fethi
F
Ghedira-Besbes
Leila
L
Harbi
Abdelaziz
A
Tahar Sfar
Mohamed
M
Sahloul Essoussi
Ahmed
A
Jeddi
Moncef
M
Ghedira
Ibtissem
I
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
D001323:Autoantibodies; D005456:Fluorescent Dyes; D007070:Immunoglobulin A; D019793:Fluorescein