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Irish Journal of Medical Science (1971 -)

, Volume 188, Issue 1, pp 135–139 | Cite as

Coeliac screening in a high-risk population: paediatric type 1 diabetes—a review of current guidelines and practice

  • Luke FordeEmail author
  • Niamh McGrath
  • Deirdre Devaney
  • Sami Awadalla
  • Ciara M. McDonnell
  • Nuala P. Murphy
Original Article
  • 132 Downloads

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.

Keywords

Coeliac disease Coeliac disease screening Paediatric type one diabetes mellitus 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Royal Academy of Medicine in Ireland 2018

Authors and Affiliations

  1. 1.Department of Paediatric EndocrinologyChildren’s University HospitalDublin 1Ireland
  2. 2.Department of HistopathologyChildren’s University HospitalDublin 1Ireland
  3. 3.Department of SurgeryChildren’s University HospitalDublin 1Ireland
  4. 4.UCD School of MedicineUniversity College DublinDublin 1Ireland

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