Screening of celiac disease in children and adolescents with type 1 diabetes mellitus

Hasret Ayyildiz Civan 1 * , Esra Papatya Çakır 2
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1 Department of Gastroenterology, Hepatology and Nutrition, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
2 Department of Pediatric Endocrinology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
* Corresponding Author
J CLIN MED KAZ, Volume 2, Issue 56, pp. 21-26. https://doi.org/10.23950/1812-2892-JCMK-00755
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ABSTRACT

Background and aim: Celiac disease is the most frequent autoimmune disease in Type 1 diabetes mellitus. We aimed to determine the celiac disease prevalence in patients with type 1 diabetes mellitus, additionally to evaluate the clinical, serological and molecular characteristics of type 1 diabetes mellitus and celiac disease which have a common genetic predisposition.
Material and methods: A total number of 76 type 1 diabetes mellitus patients aged between 1-18 years, were evaluated retrospectively. Serologic screening for celiac disease was performed via anti-tissue transglutaminase and anti-endomysial antibodies. Presence of human leukocyte antigens (HLA) (DQ2 and DQ8) documented as well. Patients with positive tissue transglutaminase and endomysial antibodies underwent endoscopic biopsy. Histopathological analysis were performed according to the modified Marsh classification. Patients' demographic characteristics, anthropometric measurements, physical examination, laboratory findings, age at type 1 diabetes mellitus and celiac disease onset, and celiac disease prevalence were evaluated. In addition all findings were compared between type 1 diabetes mellitus patients and newly diagnosed celiac disease patients.
Results: Serum tissue transglutaminase was positive in 14,5% (n=11) of all patients and serum endomysial antibodies was positive in 13,2% (n=10). The overall prevalence of celiac disease in type 1 diabetes mellitus was confirmed as 10.5% (n=8) by histopathological examination in present study. Of the celiac disease patients 37.5% were asymptomatic. In addition, 6 were anti-tissue transglutaminase and 7 were endomysial antibodies positive. Moreover, 60.3% (n=41) were HLADQ2 and 58.8% (n=40) were HLA-DQ8 positive. Selective IgA deficiency was described in 3 cases. In one of them HLA-DQ2/HLA-DQ8 was found positive and celiac disease diagnosis was confirmed by biopsy. HLA-DQ8 ratio was found significantly higher in patients with celiac disease than the type 1 diabetes mellitus patients. In addition, HLA-DQ2/DQ8 positivity was observed in 62.5% (n=5) of celiac disease patients.
Conclusion: Our findings have demonstrated the increasing prevalence of celiac disease in children with type 1 diabetes mellitus. Particularly the higher risk of asymptomatic celiac disease in type 1 diabetes mellitus patients, revealed the diagnostic value of serological screening. Furthermore, increased HLA-DQ2 and HLA-DQ8 positivity, which are more prominent in case of selective IgA deficiency, clearly demonstrates the requirement of routine total IgA and HLA analysis in serological screening.

CITATION

Ayyildiz Civan H, Papatya Çakır E. Screening of celiac disease in children and adolescents with type 1 diabetes mellitus. Journal of Clinical Medicine of Kazakhstan. 2020;2(56):21-6. https://doi.org/10.23950/1812-2892-JCMK-00755

REFERENCES

  • Volta U, Tovoli F, Caio G. Clinical and immunological features of celiac disease in patients with type 1 diabetes mellitus. Expert review of gastroenterology & hepatology. 2011; 5(4):479-87. https://doi.org/10.1586/egh.11.38
  • Triolo TM, Armstrong TK, McFann K, Yu L, Rewers MJ, Klingensmith GJ, Eisenbarth GS, Barker JM. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes care. 2011; 34(5):1211-3. https://doi.org/10.2337/dc10-1756
  • Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig ME. Screening for celiac disease in type 1 diabetes: a systematic review. Pediatrics. 2015; 136(1):e170-6. https://doi.org/10.1542/peds.2014-2883
  • Mahmud FH, Murray JA, Kudva YC, Zinsmeister AR, Dierkhising RA, Lahr BD, Dyck PJ, Kyle RA, El-Youssef M, Burgart LJ, Van Dyke CT. Celiac disease in type 1 diabetes mellitus in a North American community: prevalence, serologic screening, and clinical features. InMayo Clinic Proceedings. 2005; 80(11):1429-1434). Elsevier. https://doi.org/10.4065/80.11.1429
  • Elfström P, Sundström J, Ludvigsson JF. Systematic review with meta‐analysis: associations between coeliac disease and type 1 diabetes. Alimentary pharmacology & therapeutics. 2014; 40(10):1123-32. https://doi.org/10.1111/apt.12973
  • Ludvigsson JF, Ludvigsson J, Ekbom A, Montgomery SM. Celiac disease and risk of subsequent type 1 diabetes: a general population cohort study of children and adolescents. Diabetes Care. 2006; 29:2483-8. https://doi.org/10.2337/dc06-0794 
  • Valerio G, Maiuri L, Troncone R et al. Severe clinical onset of diabetes and increate prevalence of other autoimmune diseases in children with celiac disease diagnosed before diabetes mellitus. Diabetologica. 2002; 45 (12):1719-1722. https://doi.org/10.1007/s00125-002-0923-5
  • Leeds JS, Hopper AD, Hadjivassiliou M, Tesfaye S, Sanders DS. High prevalence of microvascular complications in adults with type 1 diabetes and newly diagnosed celiac disease. Diabetes care. 2011; 34(10):2158-63. https://doi.org/10.2337/dc11-0149
  • Holmes GK. Coeliac disease and Type 1 diabetes mellitus-the case for screening. Diabetic Medicine. 2001; 18(3):169-77. https://doi.org/10.1046/j.1464-5491.2001.00498.x
  • Pham-Short A, Donaghue KC, Ambler G, Phelan H, Twigg S, Craig ME. Screening for celiac disease in type 1 diabetes: a systematic review. Pediatrics. 2015; 136(1):e170-6. https://doi.org/10.1542/peds.2014-2883
  • Oberhuber G, Granditsch G, Vogelsang H. The histopathology of coeliac disease: time for a standardized report scheme for pathologists. European journal of gastroenterology & hepatology. 1999; 11(10):1185-94. https://doi.org/10.1097/00042737-199910000-00019
  • Camarca ME, Mozzillo E, Nugnes R, Zito E, Falco M, Fattorusso V, Mobilia S, Buono P, Valerio G, Troncone R, Franzese A. Celiac disease in type 1 diabetes mellitus. Italian journal of pediatrics. 2012; 38(1):10. https://doi.org/10.1186/1824-7288-38-10
  • Rami B, Sumnik Z, Schober E, Waldhör T, Battelino T, Bratanic N, Kürti K, Lebl J, Limbert C, Madacsy L, Odink RJ. Screening detected celiac disease in children with type 1 diabetes mellitus: effect on the clinical course (a case control study). Journal of pediatric gastroenterology and nutrition. 2005; 41(3):317-21. https://doi.org/10.1097/01.mpg.0000174846.67797.87
  • Deja G, Myrda A, Jarosz-Chobot P, Siekiera U. The assessment of autoimmunological status and prevalence of different forms of celiac disease among children with type 1 diabetes mellitus and celiac disease. Mediators of inflammation. 2008. https://doi.org/10.1155/2008/285989
  • Akirov A, Pinhas-Hamiel O. Co-occurrence of type 1 diabetes mellitus and celiac disease. World journal of diabetes. 2015; 6(5):707. https://doi.org/10.4239/wjd.v6.i5.707
  • Ergür AT, Öçal G, Berberoğlu M, Adıyaman P, Şıklar Z, Aycan Z, Evliyaoğlu O, Kansu A, Girgin N, Ensari A. Celiac Disease and Autoimmune Thyroid Disease in Children with Type 1 Diabetes Mellitus: Clinical and HLA− Genotyping Results. Journal of clinical research in pediatric endocrinology. 2010; 2(4):151. https://doi.org/10.4274/jcrpe.v2i4.151
  • Joshi R, Madvariya M. Prevalence and clinical profile of celiac disease in children with type 1 diabetes mellitus. Indian journal of endocrinology and metabolism. 2015; 19(6):797. https://doi.org/10.4103/2230-8210.167555
  • Tsouka A, Mahmud FH, Marcon MA. Celiac disease alone and associated with type 1 diabetes mellitus. Journal of pediatric gastroenterology and nutrition. 2015; 61(3):297-302. https://doi.org/10.1097/MPG.0000000000000789
  • Ozdemir H, Kutlu T, Ozdemir M, Isguven P, Erkan T, Cokugras FC, Dervisoglu S. Prevalence of celiac disease in children with type 1 diabetes mellitus and the accuracy of serological tests. Medicine. 2018; 7(4):882-5. https://doi.org/10.5455/medscience.2018.07.8901
  • Yildirmaz S, Altay D, Esen I, Dogan Y. Prevalence of Celiac Disease in Children With Type 1 Diabetes Mellitus in Southeast Region of Turkey. International Journal of Clinical Pediatrics. 2016; 5(2):32-5. https://doi.org/10.14740/ijcp239w
  • Bolad A, Farouk A, Lutfi MF, Nemeiri M. Association between diabetes mellitus type 1 and celiac disease: case-control study among Sudanese patients 2009-2011. Sudan Journal of Medical Sciences. 2012; 7(2):105-10.
  • Singh P, Seth A, Kumar P, Sajjan S. Coexistence of celiac disease & type 1 diabetes mellitus in children. The Indian journal of medical research. 2017; 145(1):28. https://doi.org/10.4103/ijmr.IJMR_199_15
  • Akirov A, Pinhas-Hamiel O. Co-occurrence of type 1 diabetes mellitus and celiac disease. World journal of diabetes. 2015; 6(5):707. https://doi.org/10.4239/wjd.v6.i5.707
  • Ghawil M, Miotti V, Tonutti E, Tenore A, Hadeed I, Sindici C, Visentini D, Morgham A, Abusrewil S. HLA-DQ types of celiac disease in Libyan children with type 1 diabetes mellitus. European journal of gastroenterology & hepatology. 2012; 24(1):59-63. https://doi.org/10.1097/MEG.0b0 13e32834d09d4
  • Dezsofi A, Szebeni B, Hermann CS, Kapitany A, Veres G, Sipka S, Körner A, Madácsy L, Korponay-Szabó I, Rajczy K, Arató A. Frequencies of genetic polymorphisms of TLR4 and CD14 and of HLA-DQ genotypes in children with celiac disease, type 1 diabetes mellitus, or both. Journal of pediatric gastroenterology and nutrition. 2008; 47(3):283-7. https://doi.org/10.1097/MPG.0b013e31816de885