Prevalence of celiac disease in patients with type 1 diabetes mellitus

ABSTRACT

Celiac disease is an autoimmune disorder in genetically susceptible individuals after ingestion of gluten. Early diagnosis and treatment of celiac disease could potentially prevent the development of serious complications like osteoporosis, small bowel lymphoma, and infertility. Nowadays, the availability of non-invasive serological tests for celiac disease altered the classical diagnostic pathway, and allows screening of populations at particular risk of developing celiac disease. Celiac disease is associated with many other autoimmune disorders, type 1 diabetic patients may have the risk of developing celiac disease or one of its complication. to determine the prevalence of celiac disease in adult patients with type 1 diabetes mellitus attending the outpatient diabetic clinic of Alexandria University Main Hospital. 200 adult patients with type 1 diabetes mellitus screened for celiac disease by anti-endomysial [EMA] IgA antibodies, and anti-tissue transglutaminase [tTG] IgA antibodies, In addition, Anti-endomysial [EMA] IgG antibodies used to detect patients with IgA deficiency. Distal duodenal biopsy and histopathological examination was performed for any serologically positive patient. Eight [4%] patients showed positive results for all performed serological tests. They all confirmed to be celiac diseased by histopathological examination of distal duodenal biopsy. Anther three patients showed only weak positive liter for tTG-lgA and all of them revealed normal mucosal histopathological finding. Anti- endomysial [EMA] IgA assay showed optimal concordance with histopathological finding. In three patients of the celiac group; the disease was asymptomatic. Symptoms [anemia, fatigue, short stature, diarrhea abdominal distension, recurrent aphthus ulcer, and recurrent hypoglycaemic attacks] in a mild form were significantly higher in the diabetic-celiac group than that in diabetic non-celiac group. There were no significant differences between the diabetic-celiac group and diabetic non-celiac group as regard age, diabetic onset, duration, or glycemic control. Patients with type 1 diabetes mellitus have an increased prevalence of celiac disease. Because most cases are clinically unrecognized, consideration should be given to screening all patients with type 1 diabetes. EMA serological screening and confirmatory histopathological examination of distal duodenal biopsy remain the best screening strategy to detect celiac disease in patients with type 1 diabetes