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Celiac disease can be predicted by high levels of tissue transglutaminase antibodies in children and adolescents with type 1 diabetes
Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Lund University, Lund, Sweden.
Karolinska Institutet, Stockholm, Sweden.
Children Clinic, Halland's Hospital, Halmstad, Sweden.
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2021 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 22, no 3, p. 417-424Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Children with type 1 diabetes (T1D) are not included in guidelines regarding diagnosis criteria for celiac disease (CD) without a diagnostic biopsy, due to lack of data. We explored whether tissue transglutaminase antibodies (anti-tTG) that were ≥10 times the upper limit of normal (10× ULN) predicted CD in T1D.

METHODS: Data from the Swedish prospective Better Diabetes Diagnosis study was used, and 2,035 children and adolescents with T1D diagnosed between 2005-2010 were included. Of these, 32 had been diagnosed with CD before T1D. The children without CD were repeatedly screened for CD using anti-tTG antibodies of immunoglobulin type A. In addition, their human leukocyte antigen (HLA) were genotyped. All children with positive anti-tTG were advised to undergo biopsy. Biopsies were performed on 119 children and graded using the Marsh-Oberhüber classification.

RESULTS: All of the 60 children with anti-tTG ≥10x ULN had CD verified by biopsies. The degree of mucosal damage correlated with anti-tTG levels. Among 2,003 screened children, 6.9% had positive anti-tTG and 5.6% were confirmed CD. The overall CD prevalence, when including the 32 children with CD before T1D, was 7.0% (145/2,035). All but one of the children diagnosed with CD had HLA-DQ2 and/or DQ8.

CONCLUSIONS: As all screened children and adolescents with T1D with tissue transglutaminase antibodies above 10 times the positive value 10x ULN had CD, we propose that the guidelines for diagnosing CD in screened children, when biopsies can be omitted, should also apply to children and adolescents with T1D as a non-invasive method.

Place, publisher, year, edition, pages
Blackwell Publishing, 2021. Vol. 22, no 3, p. 417-424
Keywords [en]
Celiac disease, biopsy, screening, tissue transglutaminase antibodies, type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-87750DOI: 10.1111/pedi.13165ISI: 000597648700001PubMedID: 33259121Scopus ID: 2-s2.0-85097400725OAI: oai:DiVA.org:oru-87750DiVA, id: diva2:1506330
Funder
Swedish Child Diabetes Foundation
Note

Funding Agency:

Skane County Council's Research and Development Foundation 

Available from: 2020-12-03 Created: 2020-12-03 Last updated: 2021-05-19Bibliographically approved

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Särnblad, Stefan

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