title: Gastric autoimmunity in children and adolescents with type 1 diabetes: a prospective study.
abstract: OBJECTIVE
  Type 1 diabetes (T1DM) is associated with gastric autoimmunity, which is characterized by the presence of parietal cell antibodies (APCA). We investigated gastric autoimmunity prevalence in T1DM children, its manifestations, determinants and association with thyroid gland (anti-Tg, anti-TPO) and pancreatic β-cell autoimmunity (anti-GAD) at baseline and 4 years later.
  
  
  METHODS
  The initial cohort (D1) included 97 children with T1DM. At follow-up after 4 years (D2), 84.5% of participants were evaluated. We assessed APCA, anti-Tg, anti-TPO, and anti-GAD presence, as well as symptoms of gastritis. APCA-positive patients were evaluated with gastrin, B₁₂, ferritin levels and were submitted to gastroscopy.
  
  
  RESULTS
  Thyroid antibody positivity was increased among the APCA-positive patients. Four years later, among initially APCA-positive patients, 2/6 became APCA negative, while 4/6 developed high titers of APCA. On gastroscopy, 2 patients had chronic hypertrophic gastritis and one Helicobacter pylori gastritis.
  
  
  CONCLUSIONS
  Gastric autoimmunity was associated with thyroid autoimmunity and anti-GAD persistence. After 4 years, the majority of APCA-positive patients developed high titers of APCA and mild symptoms of gastritis. Thus, patients with T1DM, and in particular those with thyroid and/or pancreatic autoimmunity, should have periodic autoantibody screening for the early diagnosis and follow-up of gastric autoimmunity.
authors.affiliation: Diabetic Clinic, Second University Department of Pediatrics, P. & A. Kyriakou Children's Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece. kkarav@yahoo.gr
authors.forename: K
authors.initials: K
authors.lastname: Kakleas
authors.forename: M
authors.initials: M
authors.lastname: Kostaki
authors.forename: E
authors.initials: E
authors.lastname: Critselis
authors.forename: C
authors.initials: C
authors.lastname: Karayianni
authors.forename: M
authors.initials: M
authors.lastname: Giannaki
authors.forename: K
authors.initials: K
authors.lastname: Anyfantakis
authors.forename: I
authors.initials: I
authors.lastname: Haramaras
authors.forename: A
authors.initials: A
authors.lastname: Fotinou
authors.forename: A
authors.initials: A
authors.lastname: Papathanasiou
authors.forename: K
authors.initials: K
authors.lastname: Karavanaki
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000032:analysis; D015551:Autoimmunity; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000276:immunology*; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000150:complications; D005968:Glutamate Decarboxylase / Q000037:antagonists & inhibitors; D006115:Greece; D006785:Hospitals, University; D006801:Humans; D050417:Insulin-Secreting Cells / Q000276:immunology; D008297:Male; D010044:Outpatient Clinics, Hospital; D010295:Parietal Cells, Gastric / Q000276:immunology*; D011446:Prospective Studies; D013961:Thyroid Gland / Q000276:immunology
chemical_list: D001323:Autoantibodies; C056626:thyroid microsomal antibodies; D005968:Glutamate Decarboxylase