Open AccessRecommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report
Author(s) -
Şükrü Hatun,
Buket Dalgıç,
Damla Gökşen,
Sema Aydoğdu,
Şenay Savaş Erdeve,
Zarife Kuloğu,
Yaşar Doğan,
Zehra Aycan,
Gül Yeşiltepe Mutlu,
Nuray Uslu Kızılkan,
Alev Keser,
Ömer Faruk Beşer,
Mehmet Nuri Özbek,
Aysun Bideci,
Deniz Ertem,
Olcay Evliyaoğlu,
Beyza Eliuz Tipici,
Tuğba Gökçe,
Serra Muradoğlu,
Orhun Çığ Taşkın,
Tuğba Koca,
Filiz Tütüncüler,
Firdevs Baş,
Feyza Darendelıler,
Mukadder Ayşe Selimoğlu
Publication year - 2022
Publication title -
jcrpe
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.566
H-Index - 35
eISSN - 1308-5735
pISSN - 1308-5727
DOI - 10.4274/jcrpe.galenos.2021.2021.0139
Subject(s) - medicine , tissue transglutaminase , type 1 diabetes , disease , immunoglobulin a , pediatric gastroenterology , diabetes mellitus , pediatric endocrinology , immunology , antibody , pediatrics , gastroenterology , immunoglobulin g , endocrinology , biochemistry , chemistry , enzyme
It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.