title: High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study.
abstract: BACKGROUND
  There is lack of data on prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) in Arabs in the Middle East. The present investigation aims to study the prevalence rate and clinical characteristics of CD among Saudi children with T1D using a combination of the most sensitive and specific screening serologic tests (anti- tissue transglutaminase antibodies IgA [anti-TTG] and ednomyseal antibodies [EMA]) and to determine the lower cut-off value of anti- anti-TTG level that best predicts CD in children with T1D.
  
  
  METHODS
  Children with T1D following in diabetic clinic have been prospectively screened for presence of CD, over a two-year period (2008-2010), by doing anti-TTG, EMA, and total IgA. Children with positive anti-TTG titres (>50 U/ml) and/or EMA and children with persistently low positive anti-TTG titres (two readings 20-50 U/ml; within 6 months intervals) had upper endoscopy and 6 duodenal biopsies.
  
  
  RESULTS
  One hundred and six children with T1D have been screened for CD: age ranged between 8 months to 15.5 years (62 females). Nineteen children had positive anti-TTG and/or EMA, however only 12 children had biopsy proven CD (11.3%). Five of 12 had gastrointestinal symptoms (42%). Children with T1D and CD had significantly lower serum iron than children with T1D alone (8.5 μgm/L Vs 12.5 μgm/L; P = 0.014). The sensitivity and specificity of anti-TTG were 91.6% and 93.6%, with a positive and negative predictive value of 64.7% and 98.8%, respectively. Receiver operated characteristics analysis for the best cut-off value of anti-TTG level for diagnosis of CD was 63 units (sensitivity 100% and specificity 98.8%).
  
  
  CONCLUSIONS
  CD is highly prevalent among Saudi children with T1D. Anti-TTG titres more than 3 times the upper limit of normal has very high sensitivity and specificity for diagnosis of CD in T1D children.
authors.affiliation: Department of Pediatrics at Children's Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. aa_alhussaini@yahoo.com
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Al-Hussaini
authors.forename: Nimer
authors.initials: N
authors.lastname: Sulaiman
authors.forename: Musa
authors.initials: M
authors.lastname: Al-Zahrani
authors.forename: Ahmed
authors.initials: A
authors.lastname: Alenizi
authors.forename: Imad
authors.initials: I
authors.lastname: El Haj
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000097:blood; D001706:Biopsy; D002446:Celiac Disease / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D005260:Female; D019204:GTP-Binding Proteins; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D007223:Infant; D007421:Intestine, Small / Q000473:pathology*; D007501:Iron / Q000097:blood; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012372:ROC Curve; D012529:Saudi Arabia / Q000453:epidemiology; D011503:Transglutaminases / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D007501:Iron; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins