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

Edip Unal, Meliha Demiral, Birsen Baysal, Mehmet Ağın, Elif Gökçe Devecioğlu, Hüseyin Demirbilek, Mehmet Nuri Özbek, Edip Unal, Meliha Demiral, Birsen Baysal, Mehmet Ağın, Elif Gökçe Devecioğlu, Hüseyin Demirbilek, Mehmet Nuri Özbek

Abstract

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

Methods: The data of 668 patients with available celiac serology tests from a total of 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%). In 46 out of 53 (86.8%) patients with positive serology and biopsy, CD diagnosis was confirmed by biopsy (BPCD). The frequency of BPCD was 6.9%, and the serology in 76.1% was positive at the time of diagnosis of T1DM. The weight, height and body mass index-standard deviation score at diagnosis were lower in patients with BPCD compared to the group without CD. An anti-tissue transglutaminase-IgA (anti-TTG-IgA) level of 11.8 times the upper limit of normal was the most sensitive (93%) and specific (90%) cut-off for BPCD (area under the curve: 0.95; 95% confidence interval: 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 (GFD). Therefore, serological follow-up instead of immediate duodenal biopsy or GFD therapy, particularly for patients with asymptomatic and mild anti-TTG IgA level, is warranted.

Keywords: Celiac disease; children; spontaneous normalization; type 1 diabetes.

Figures

Figure 1
Figure 1
A flow diagram of the study participants T1DM: type 1 diabetes mellitus, CD: celiac disease, anti-TTG IgA: antitissue transglutaminase-IgA
Figure 2
Figure 2
Trend of the anti-tissue transglutaminase-IgA levels in patients with persistent, fluctuation and spontaneous normalization group
Figure 3
Figure 3
Receiver operating characteristics analysis of antitissue transglutaminase-IgA level for prediction of biopsyproven celiac disease (sensitivity: 93%, specificity: 90%, area under the curve: 0.95, p

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