Original Article

Frequency of Celiac Disease and Spontaneous Normalization Rate of Celiac Serology in Children and Adolescent Patients with Type 1 Diabetes

10.4274/jcrpe.galenos.2020.2020.0108

  • Edip Unal
  • Meliha Demiral
  • Birsen Baysal
  • Mehmet Agın
  • Elif Gökçe Devecioğlu
  • Hüseyin Demirbilek
  • Mehmet Nuri Özbek

Received Date: 17.05.2020 Accepted Date: 14.08.2020 J Clin Res Pediatr Endocrinol 0;0(0):0-0 [e-Pub] PMID: 32820875

Purpose:

The prevalence of celiac disease (CD) varies between 1% and 10% in patients with type 1 diabetes mellitus(T1DM). This study aims to determine the frequency of spontaneous recovery of celiac serology and the biopsy-proven CD frequency (BPCD) in patients with T1DM.

Methods:

The data of 668 patients with celiac serology from 779 patients who were followed for the last 10 years with the diagnosis of T1DM were retrospectively evaluated.

Results:

Positive serology was detected in 103 out of 668(15.4%) patients. There was spontaneous normalization in 24(23.3%), fluctuation in 11(10.7%) and permanently positive serology in 68(66%) of these patients. In 46 out of 53(86.8%) patients with positive serology diagnosis of CD was confirmed with a biopsy (BPCD). The frequency of BPCD was 6.9%, and the serology in 76.1% of them was positive at the time of the diagnosis of T1DM. The weight, height and BMI-SDS at the time of diagnosis were lower in patients with BPCD compared to the group without CD. The anti-tissue transglutaminase-IgA level of 11.8 times higher than the upper limit of normal revealed the best sensitivity (93%) and specificity (90%) for BPCD (AUC:0.95; 95% CI: 0.912-1; p<0.001).

Conclusion:

In our cohort, the frequency of positive serology for CD was 15.4%, while the rate of BPCD was 6.9%. The majority (97.8%) of cases were diagnosed within the first five years of T1DM. In 23.3% of cases, positive anti-TTG-IgA spontaneously resolved without a gluten-free diet. Therefore, serological follow-up instead of immediate duodenal biopsy or gluten-free diet therapy, particularly for patients with asymptomatic and mild anti-TTG IgA level, is warranted.

Keywords: Celiac disease, children, spontaneous normalization, type 1 diabetes