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Celiac disease can be predicted by high levels of tissue transglutaminase antibodies in children and adolescents with type 1 diabetes
Author(s) -
Cerqueiro Bybrant Mara,
Udén Elin,
Frederiksen Filippa,
Gustafsson Anna L,
Arvidsson CarlGöran,
Fureman AnnaLena,
Forsander Gun,
Elding Larsson Helena,
Ivarsson Sten A,
Lindgren Marie,
Ludvigsson Johnny,
Marcus Claude,
Pundziute Lyckå Auste,
Persson Martina,
Samuelsson Ulf,
Särnblad Stefan,
Åkesson Karin,
Örtqvist Eva,
Carlsson Annelie
Publication year - 2021
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.13165
Subject(s) - tissue transglutaminase , medicine , type 1 diabetes , antibody , biopsy , human leukocyte antigen , diabetes mellitus , prospective cohort study , disease , immunology , gastroenterology , antigen , endocrinology , enzyme , biochemistry , chemistry
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 2035 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 2003 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% (145/2035). 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 noninvasive method.