Abstract
Background and aims
Coeliac disease (CD) is more common in those with type 1 diabetes mellitus (T1DM) and may be asymptomatic despite the presence of intestinal histological changes. Optimal screening practice guidelines differ internationally. We undertook a retrospective audit to determine the efficacy of current screening practice for CD in T1DM in our centre.
Methods
All children and adolescents < 16 years, diagnosed with T1DM in our service and continuing to attend the service in January 2017 were included. Data on CD screening was collected and compared to current NICE, NASPGHAN and ESPGHAN guidelines.
Results
Of the 355 patients attending our service, 253 attended from T1DM diagnosis and all had CD screening performed in our centre. In 37 of 253 patients, IgA-TTG was positive, providing a cumulative prevalence of 14.6%. Of these, 31(83.78%) with an elevated TTG on screening had no recorded gastrointestinal symptoms or CD-related clinical signs. Of the 35 TTG plus EMA-positive patients, 22/35 (59.46%) had diagnostic endoscopic biopsy. Nineteen (83.4%) had CD confirmed, 1 (4.54%) had negative biopsy and 2 (9%) had equivocal, non-diagnostic changes.
Conclusions
Timely diagnosis of CD can prevent chronic ill health in affected individuals, and in patients with T1DM, CD is an independent risk factor for increased morbidity and mortality. Given the high prevalence of atypical symptoms and silent CD in those with T1DM, in this and other studies, and the benefits of detection and treatment of CD, screening is essential. Large-scale data collection allowing for the development of evidence-based guidelines is required.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aktay AN, Lee PC, Kumar V, Parton E, Wyatt DT, Werlin SL (2001) The prevalence and clinical characteristics of celiac disease in juvenile diabetes in Wisconsin. J Pediatr Gastroenterol Nutr 33(4):462–465
Crone J, Rami B, Huber WD, Granditsch G, Schober E (2003) Prevalence of celiac disease and follow-up of EMA in children and adolescents with type 1 diabetes mellitus. J Pediatr Gastroenterol Nutr 37(1):67–71
Al-Hussaini A, Sulaiman N, Al-Zahrani M, Alenizi A, El Haj I (2012) High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study. BMC Gastroenterol 12:180
Bybrant MC, Ortqvist E, Lantz S, Grahnquist L (2014) High prevalence of celiac disease in Swedish children and adolescents with type 1 diabetes and the relation to the Swedish epidemic of celiac disease: a cohort study. Scand J Gastroenterol 49(1):52–58
Salardi S, Maltoni G, Zucchini S, Iafusco D, Confetto S, Zanfardino A, Toni S, Piccini B, Zioutas M, Marigliano M, Cauvin V, Franceschi R, Rabbone I, Predieri B, Schiaffini R, Salvatoni A, Reinstadler P, Berioli G, Cherubini V, d’Annunzio G, Diabetes Study Group of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED) (2016) Celiac disease negatively influences lipid profiles in young children with type 1 diabetes: effect of the gluten-free diet. Diabetes Care 39(8):e119–e120
Mohn A, Cerruto M, Iafusco D, Prisco F, Tumini S, Stoppoloni O, Chiarelli F (2001) Celiac disease in children and adolescents with type I diabetes: importance of hypoglycemia. J Pediatr Gastroenterol Nutr 32(1):37–40
Simmons JH, Klingensmith GJ, McFann K, Rewers M, Taylor J, Emery LM, Taki I, Vanyi S, Liu E, Hoffenberg EJ (2007) Impact of celiac autoimmunity on children with type 1 diabetes. J Pediatr 150(5):461–466
Abid N, McGlone O, Cardwell C, McCallion W, Carson D (2011) Clinical and metabolic effects of gluten free diet in children with type 1 diabetes and coeliac disease. Pediatr Diabetes 12(4 Pt 1):322–325
Sud S, Marcon M, Assor E, Daneman D, Mahmud FH (2012) Quality of life in children with diabetes and celiac disease: minimal impact of the ‘double diagnosis’. Pediatr Diabetes 13(2):163–169
Ludvigsson JF, Lebwohl B (2017) Screening for coeliac disease in type 1 diabetes. Acta Paediatr 106(4):530–531
Mollazadegan K, Fored M, Lundberg S, Ludvigsson J, Ekbom A, Montgomery SM, Ludvigsson JF (2014) Risk of renal disease in patients with both type 1 diabetes and coeliac disease. Diabetologia 57(7):1339–1345
Mollazadegan K, Kugelberg M, Montgomery SM, Sanders DS, Ludvigsson J, Ludvigsson JF (2013) A population-based study of the risk of diabetic retinopathy in patients with type 1 diabetes and celiac disease. Diabetes Care 36(2):316–321
Weiss B, Pinhas-Hamiel O (2017) Celiac disease and diabetes: when to test and treat. J Pediatr Gastroenterol Nutr 64(2):175–179
Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (2005) Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 40(1):1–19
Husby S, Koletzko S, Korponay-Szabo IR, Mearin ML, Phillips A, Shamir R et al (2012) European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 54(1):136–160
Hill ID, Fasano A, Guandalini S, Hoffenberg E, Levy J, Reilly N, Verma R (2016) NASPGHAN clinical report on the diagnosis and treatment of gluten-related disorders. J Pediatr Gastroenterol Nutr 63(1):156–165
Downey L, Houten R, Murch S, Longson D, Guideline Development G (2015) Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance. BMJ 351:h4513
Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA, American College of G (2013) ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 108(5):656–676 quiz 77
Csizmadia CG, Mearin ML, Oren A, Kromhout A, Crusius JB, von Blomberg BM et al (2000) Accuracy and cost-effectiveness of a new strategy to screen for celiac disease in children with Down syndrome. J Pediatr 137(6):756–761
Leffler D, Schuppan D, Pallav K, Najarian R, Goldsmith JD, Hansen J, Kabbani T, Dennis M, Kelly CP (2013) Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease. Gut 62(7):996–1004
Gidrewicz D, Potter K, Trevenen CL, Lyon M, Butzner JD (2015) Evaluation of the ESPGHAN celiac guidelines in a North American pediatric population. Am J Gastroenterol 110(5):760–767
Sandstrom O, Rosen A, Lagerqvist C, Carlsson A, Hernell O, Hogberg L et al (2013) Transglutaminase IgA antibodies in a celiac disease mass screening and the role of HLA-DQ genotyping and endomysial antibodies in sequential testing. J Pediatr Gastroenterol Nutr 57(4):472–476
Kurppa K, Ashorn M, Iltanen S, Koskinen LL, Saavalainen P, Koskinen O et al (2010) Celiac disease without villous atrophy in children: a prospective study. J Pediatr 157(3):373–380 80 e1
Lionetti E, Castellaneta S, Pulvirenti A, Tonutti E, Francavilla R, Fasano A, Catassi C, Italian Working Group of Weaning and Celiac Disease Risk (2012) Prevalence and natural history of potential celiac disease in at-family-risk infants prospectively investigated from birth. J Pediatr 161(5):908–914
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Forde, L., McGrath, N., Devaney, D. et al. Coeliac screening in a high-risk population: paediatric type 1 diabetes—a review of current guidelines and practice. Ir J Med Sci 188, 135–139 (2019). https://doi.org/10.1007/s11845-018-1831-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-018-1831-0