Celiac and Endocrine Autoimmune Disorders in Children
Celiac and Endocrine Autoimmune Disorders in Children
The association of T1D with other AI in the same subject is relatively common, and it affects the management of the disease in childhood and adolescence. Epidemiological studies reported that CD prevalence in T1D patients ranges from 4 to 11% in comparison to 1% of the general population.
Screening for CD is now recommended in T1D children at disease onset, annually in the first 4 years of the disease, and every 2 years in the following 6 years. Screening is commonly performed by means of IgA antitransglutaminase (confirmed by antiendomysial antibodies) or IgG antitransglutaminase in subjects with IgA deficiency. In the presence of CD-related antibodies positivity, it is mandatory to perform bowel biopsy to confirm diagnosis of CD, even if recent guidelines of the ESPGHAN Society suggest that in clinically evident CD cases, bowel biopsy could be avoided (four major criteria).
A recent paper reported that antitransglutaminase antibodies normalized at 1-year follow-up in 35.4% of children found positive for antitransglutaminase antibodies within 4 months from T1D diagnosis and who continued to take gluten. A lower proportion of children also showed a concurrent spontaneous normalization of antiendomysial antibodies. At 1-year follow-up, no significant differences were evident in terms of HbA1c levels and growth parameters between T1D children on GFD (for confirmed CD) and T1D children found positive for CD-antibodies who continued gluten-containing diet. The authors suggested that T1D children with mildly elevated antitransglutaminase antibodies at T1D onset should be monitored serologically on a gluten-containing diet, for at least 12 months, rather than undergoing immediately duodenal biopsy.
In most T1D patients, diabetes is the first to be diagnosed, while CD precedes T1D onset in 10–25% of subjects, whose mean age (at CD diagnosis) of clinically symptomatic CD is around 2–3 years, whereas mean age at T1D onset is around 7–8 years. CD in T1D patients is commonly asymptomatic or slightly symptomatic, and the diagnosis is reached through the routine screening performed at clinical onset of T1D in 70–80% of cases.
CD & T1D
The association of T1D with other AI in the same subject is relatively common, and it affects the management of the disease in childhood and adolescence. Epidemiological studies reported that CD prevalence in T1D patients ranges from 4 to 11% in comparison to 1% of the general population.
Screening for CD is now recommended in T1D children at disease onset, annually in the first 4 years of the disease, and every 2 years in the following 6 years. Screening is commonly performed by means of IgA antitransglutaminase (confirmed by antiendomysial antibodies) or IgG antitransglutaminase in subjects with IgA deficiency. In the presence of CD-related antibodies positivity, it is mandatory to perform bowel biopsy to confirm diagnosis of CD, even if recent guidelines of the ESPGHAN Society suggest that in clinically evident CD cases, bowel biopsy could be avoided (four major criteria).
A recent paper reported that antitransglutaminase antibodies normalized at 1-year follow-up in 35.4% of children found positive for antitransglutaminase antibodies within 4 months from T1D diagnosis and who continued to take gluten. A lower proportion of children also showed a concurrent spontaneous normalization of antiendomysial antibodies. At 1-year follow-up, no significant differences were evident in terms of HbA1c levels and growth parameters between T1D children on GFD (for confirmed CD) and T1D children found positive for CD-antibodies who continued gluten-containing diet. The authors suggested that T1D children with mildly elevated antitransglutaminase antibodies at T1D onset should be monitored serologically on a gluten-containing diet, for at least 12 months, rather than undergoing immediately duodenal biopsy.
In most T1D patients, diabetes is the first to be diagnosed, while CD precedes T1D onset in 10–25% of subjects, whose mean age (at CD diagnosis) of clinically symptomatic CD is around 2–3 years, whereas mean age at T1D onset is around 7–8 years. CD in T1D patients is commonly asymptomatic or slightly symptomatic, and the diagnosis is reached through the routine screening performed at clinical onset of T1D in 70–80% of cases.