Prevalence of celiac disease in Egyptian children and adolescents with insulin dependent diabetes mellitus: a biochemical and histopathologic study

ABSTRACT

Diagnosis of atypical and silent celiac disease [CD] is important because of its serious complications. The association of insulin dependent diabetes mellitus [DDM] and CD has been reported worldwide. The aim of this study was to determine the prevalence and clinical, biochemical and histopathologic characteristics of CD among Egyptian children and adolescents with IDDM. A total of 116 children and adolescents with IDDM [62 males and 54 females, age rage 2-21 yrs] and 25 age and sex matched healthy children were screened for CD using anti-gliadin [AGA], anti-tissue transglutaminase [t-TG], anti-reticulin [AGA] and anti-endomysial [EmA] antibodies. Clinical data, hemoglobin Air, insulin requirements, hemoglobin concentration, mean red cell volume and serum ferritin levels were evaluated. Twenty six [22.4%] patients were positive for AGA and ITG antibodies, 14 of them were ARA positive. Ten of these patients were EmA positive and four were EmA negative. From the EmA negative patients three sera with IgA deficiency had high lgG class in AGA, anti-t-TG and ARA antibodies. All these 14 patients [EmA positive and negative] underwent intestinal biopsy. Thirteen had histological evidence of CD including the EmA negative patients with IgA deficiency, giving a prevalence of CD in diabetic children of 11.2% [13/116]. Compared with the other diabetic patients, those with CD had a significantly higher height SD scores with no statistical significant changes in any other parameters. The prevalence of CD in Egyptian IDDM children and adolescents was found to the high. Serologic markers for CD are useful for identifying asymptomatic IDDM children who should undergo a small intestinal biopsy