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Abstracts: Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Denver, October 21-24, 1999


Gillett, P; Gillett, H; Israel, D; Metzger, D; Stewart, L; Chanoine, J-P; Freeman, H

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Journal of Pediatric Gastroenterology & Nutrition: October 1999 - Volume 29 - Issue 4 - p 495
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Abstract 23

Background and Aim Studies have established that children with type 1 diabetes are at increased risk of celiac disease (CD). Few have been performed in N. America and we aimed to confirm whether the prevalence in BC is comparable to Europe. Methods So far we have prospectively screened 232 of 700 children with type 1 diabetes attending our center. Serum was tested blindly for IgA endomysial antibody (EmA) against human umbilical cord and an ELISA for IgA tissue transglutaminase antibody (tTG) using guinea pig tTG. Those with positive result(s) were offered small bowel biopsy. Results Nineteen were positive for EmA and had elevated tTG [median 5700 AU/ml, range 198 - 35900 AU/ml (reference range < 140 AU/ml)]. One of this group was already known to have CD and 16 others have so far been biopsied. One biopsy was normal, two demonstrated elevated intra-epithelial lymphocyte counts with normal morphology and 13 were consistent with CD. They have commenced gluten-free diet (GFD). Growth was normal in all patients and 8 were asymptomatic. Seven had elevation of tTG alone (median 188 AU/ml, range 166-433 AU/ml). One of this group with tTG of 433 AU/ml consented to biopsy, which was normal. Three treated celiac patients were among the 232 tested, being negative for both antibodies. Thirteen new cases of CD were detected, in addition to 4 known cases, making the biopsy confirmed prevalence 17/232 (7.3%) with 2 patients awaiting biopsy. Conclusion Despite the perceived low prevalence in N. America, this study confirms our CD prevalence to be comparable to Europe. Half of the cases were symptom-free, highlighting the importance of screening. Impact of GFD on metabolic control, symptoms and serology continues to be monitored in follow up. Importantly, of the 4 treated celiacs in the study, 3 were strict with GFD and had normal serology. The fourth, positive on serology, was poorly compliant. This suggests serology is useful in monitoring response and adherence to GFD. The impact of presymptomatic diagnosis on diabetic and CD long-term complications remains to be seen.

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© 1999 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,