E-ISSN: 2791-8823
Volume : 14 Issue : 1 Year : 2022
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Turkish Society for Pediatric Endocrinology and Diabetes
Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report [J Clin Res Pediatr Endocrinol]
J Clin Res Pediatr Endocrinol. 2022; 14(1): 1-9 | DOI: 10.4274/jcrpe.galenos.2021.2021.0139

Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report

Şükrü Hatun1, Buket Dalgıç2, Damla Gökşen3, Sema Aydogdu4, Şenay Savaş Erdeve5, Zarife Kuloğlu6, Yaşar Doğan7, Zehra Aycan8, Gül Yeşiltepe Mutlu1, Nuray Uslu Kızılkan9, Alev Keser10, Ömer Faruk Beşer11, Mehmet Nuri Özbek12, Aysun Bideci13, Deniz Ertem14, Olcay Evliyaoğlu15, Beyza Eliuz Tipici16, Tuğba Gökçe1, Serra Muradoğlu1, Orhun Çığ Taşkın17, Tuğba Koca18, Filiz Tütüncüler19, Firdevs Baş20, Feyza Darendeliler20, Mukadder Ayşe Selimoğlu21
1Koç University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, İstanbul, Turkey
2Gazi University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology, Ankara, Turkey
3Ege University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
4Ege University Faculty of Medicine, Department of Pediatric Gastroenterology, İzmir, Turkey
5University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
6Ankara University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Gastroenterology, Ankara, Turkey
7Fırat University Faculty of Medicine, Department of Pediatric Gastroenterology, Elazığ, Turkey
8Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
9Koç University Hospital, Department of Pediatric Gastroenterology, İstanbul, Turkey
10Ankara University Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
11İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, İstanbul, Turkey
12University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
13Gazi University Faculty of Medicine, Department of Pediatric Endocrinology and Diabetes, Ankara, Turkey
14Marmara University Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, İstanbul, Turkey
15İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey
16İstanbul University, İstanbul Faculty of Medicine, Department of Nutrition and Dietetics, İstanbul, Turkey
17Koç University Faculty of Medicine, Department of Pathology, İstanbul, Turkey
18Süleyman Demirel University Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Isparta, Turkey
19Trakya University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Edirne, Turkey
20İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
21Memorial Ataşehir/Bahçelievler Hospitals, Clinic of Pediatric Gastroenterology, Hepatology and Nutrition, İstanbul, Turkey

It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.

Keywords: Children, type 1 diabetes, Celiac disease, anti-tissue transglutaminase-IgA

Şükrü Hatun, Buket Dalgıç, Damla Gökşen, Sema Aydogdu, Şenay Savaş Erdeve, Zarife Kuloğlu, Yaşar Doğan, Zehra Aycan, Gül Yeşiltepe Mutlu, Nuray Uslu Kızılkan, Alev Keser, Ömer Faruk Beşer, Mehmet Nuri Özbek, Aysun Bideci, Deniz Ertem, Olcay Evliyaoğlu, Beyza Eliuz Tipici, Tuğba Gökçe, Serra Muradoğlu, Orhun Çığ Taşkın, Tuğba Koca, Filiz Tütüncüler, Firdevs Baş, Feyza Darendeliler, Mukadder Ayşe Selimoğlu. Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report. J Clin Res Pediatr Endocrinol. 2022; 14(1): 1-9

Corresponding Author: Şükrü Hatun, Türkiye
Manuscript Language: English
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