Digestive Diseases and Sciences

, Volume 64, Issue 2, pp 487–492 | Cite as

Celiac Disease and Celiac Antibodies in DM1 Patients: When Are Screening and Biopsy Recommended?

  • Mordechai Slae
  • Azi Romem
  • Shalom Edri
  • Ori Toker
  • Michael Wilschanski
  • David StrichEmail author
Original Article



The prevalence of celiac disease (CD) is increased in diabetes mellitus type 1 (DM1) patients. In most cases, CD is diagnosed in asymptomatic patients and hence periodic screening tests are recommended, but the timing, frequency of tests and indication for duodenal biopsy is unclear. The purpose of this study was to investigate the dynamics of CD serology in DM1 and identify risk factors for CD.


Celiac serology and duodenal biopsy results from 1990 until 2015 were collected from patients with DM1. The outcome of positive celiac serology, the incidence and risk factors for CD in DM1 patients were investigated.


A total of 314 DM1 patients who had celiac serology were identified, with follow-up period up to 23 years. Of 31 patients (9.9%) with positive celiac serology, 11(35.4%) had spontaneous normalization after various time periods. Eighteen patients were diagnosed with CD (58.1% of positive celiac serology, 5.73% of the study cohort). Age under 4.5 years was a risk factor for CD, but not family background of autoimmune diseases or gender. All patients with CD diagnosis were diagnosed during the first 6 years following DM1 diagnosis.


Screening asymptomatic DM1 patients for CD beyond 6 years after diagnosis is not recommended. Spontaneous normalization of CD serology occurs, and hence, serologic follow-up may be performed. In children with DM1 diagnosis under the age of 4.5 years or with positive CD serology at DM1 diagnosis, there is an increased risk for CD and therefore positive serology should lead to biopsy.


Celiac disease Diabetes mellitus type 1 Spontaneous normalization of celiac serology 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. All data retrieval and analyses were computerized and anonymous. The study was approved by the Clalit Health Service institutional review board.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Mordechai Slae
    • 1
    • 2
  • Azi Romem
    • 2
  • Shalom Edri
    • 3
  • Ori Toker
    • 4
  • Michael Wilschanski
    • 1
    • 2
  • David Strich
    • 2
    • 5
    • 6
    Email author
  1. 1.Pediatric Gastroenterology UnitHadassah-Hebrew University Medical CenterJerusalemIsrael
  2. 2.Faculty of MedicineHebrew University Medical SchoolJerusalemIsrael
  3. 3.Health Information CenterClalit Health ServicesJerusalemIsrael
  4. 4.Pediatric Allergy and Immunology UnitShaare Zedek Medical CenterJerusalemIsrael
  5. 5.Pediatric Specialist ClinicClalit Health ServicesJerusalemIsrael
  6. 6.Pediatric Endocrine UnitShaare Zedek Medical CenterJerusalemIsrael

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