Prevalence of Celiac disease in Turkish children with type 1 Diabetes Mellitus and their

INTRODUCTION

Type 1 Diabetes Mellitus (T1DM) is a common au￾toimmune disease in children. The risk for other

autoimmune disorders is increased in children

with T1DM and their relatives (1). Recent data ha￾ve supported that Celiac disease (CD) is an auto￾immune disease triggered by the ingestion of glu￾ten in genetically susceptible individuals (2).

Strong evidence for the association between T1DM

and CD has been shown in children. Up to 8% of

patients with T1DM have the characteristic featu￾Turk J Gastroenterol 2010; 21 (1): 34-38

Manuscript received: 08.11.2008 Accepted: 05.11.2009

doi: 10.4318/tjg.2010.0045

Address for correspondence: Ediz YEfi‹LKAYA

Gülhane Askeri T›p Akademisi

Çocuk Klini¤i Etlik, Ankara, Turkey

E-mail: [email protected]

Prevalence of Celiac disease in Turkish children with

type 1 Diabetes Mellitus and their non-diabetic

first-degree relatives

Tip 1 Diyabetli Türk çocuklar›nda ve onlar›n birinci derecede yak›nlar›nda Çölyak

hastal›¤› s›kl›¤›

Sinan SARI1

, Ediz YEfi‹LKAYA2

, Ödül E⁄R‹TAfi1

, Aysun B‹DEC‹2

, Peyami C‹NAZ2

, Buket DALGIÇ1

Departments of 1

Pediatric Gastroenterology and 2

Pediatric Endocrinology, Gazi University, School of Medicine, Ankara

Amaç: Bu çal›flmada tip 1 diyabetli Türk çocuklar›nda ve on￾lar›n diyabetik olmayan birinci derece yak›nlar›nda Çölyak

hastal›¤› s›kl›¤›n›n araflt›r›lmas› amaçlanm›flt›r. Yöntem: Tip

I diabetes mellitus tan›l› 48 çocuk (K/E=30/18, yafl aral›¤› 3,5-

23 y›l, yafl ortalamas› 12.09 ± 4.78 y›l), diyabetik olmayan 29

kardefl, 40 ebeveyn ve 103 sa¤l›kl› çocuk anti-doku transgluta￾minaz›, IgA, IgG ve serum total IgA düzeyleri bak›larak Çölyak

hastal›¤› için tarand›. Antikor pozitifli¤i saptanan olgulara in￾ce barsak biyopsisi yap›lmas› teklif edildi. Bulgular: 48 diya￾betli çocu¤un 8’inde anti-doku transglutaminaz› IgA pozitifli¤i

saptand›. ‹ki diyabetli çocukta selektif IgA eksikli¤i saptand› ve

her ikisinde de anti-doku transglutaminaz› IgG pozitifti. ‹ntes￾tinal biyopsi, Çölyak serolojisi pozitif 10 hastan›n 8’i (%80) ta￾raf›ndan kabul edildi. Üç diyabetik çocukta (%6,3) total villöz

atrofi tespit edildi. Bir kardefl ve ebeveynlerin ikisinde anti-do￾ku transglutaminaz›-IgA pozitif bulundu. Kardeflte biyopsi ile

Çölyak hastal›¤› do¤ruland›. Ebeveynler intestinal biyopsiyi

kabul etmedi. Diyabetik çocuklar›n akrabalar›nda biyopsi ile

kan›tlanm›fl Çölyak hastal›¤› s›kl›¤› %1,4 olarak bulundu.

Kontrol grubunda hiçbir çocukta anti-doku transglutaminaz›

pozitifli¤i tespit edilmedi. Sonuç: Diyabetli çocuklarda Çölyak

hastal›¤› s›kl›¤›n›n sa¤l›kl› çocuklara göre yüksek oranda oldu-

¤u görüldü. Diyabetik çocuklar›n akrabalar›nda biyopsi ile ka￾n›tlanm›fl Çölyak hastal›¤› s›kl›¤›nda kontrol grubuna göre

fark bulunmad›.

Anahtar kelimeler: Tip I diyabet, Çölyak hastal›¤›, çocuk, akra￾balar

Background/aims: The objective of this study was to determi￾ne the prevalence of Celiac disease in Turkish children with

type 1 Diabetes Mellitus and their non-diabetic first-degree re￾latives. Methods: Forty-eight children with type 1 Diabetes

Mellitus (18 males, 30 females; age range: 3.5 to 23 years; mean

age: 12.09 ± 4.78 years), 29 non-diabetic siblings, 40 non-diabe￾tic parents, and 103 healthy children were screened for celiac

disease using the IgA and IgG anti-tissue transglutaminase an￾tibody and total serum IgA. Small intestinal biopsy was offered

to all antibody-positive patients. Results: Eight of 48 diabetic

patients had positive anti-tissue transglutaminase IgA. Selecti￾ve IgA deficiency was detected in 2 diabetic children and both

were positive to anti-tissue transglutaminase IgG. Intestinal bi￾opsy was accepted by 8 of 10 (80%) diabetic children with posi￾tive celiac serology. Pathologic examination showed total villo￾us atrophy in 3 (6.3%) diabetic children. Positive anti-tissue

transglutaminase IgA was found in 1/29 siblings and 2/40 pa￾rents. Celiac disease was confirmed by biopsy in the sibling.

Two parents refused the biopsy. The frequency of biopsy-proven

celiac disease was found as 1.4 in relatives of diabetic children.

None of the serum samples of healthy children comprising the

control group showed selective IgA deficiency or positivity for

anti-tissue transglutaminase IgA antibody. Conclusions: The￾se findings indicate that the prevalence of celiac disease in Tur￾kish children with type 1 diabetes mellitus is higher than in he￾althy controls. The 1.4% frequency of Celiac disease in relatives

of diabetic children is close to that of controls.

Key words: Type I diabetes, Celiac disease, children, relatives