The Prevalence of Celiac Disease in Patients with Diabetes Mellitus—The Prevalence of Celiac Disease

Deniz Gökalp, Senay Arıkan, Mustafa Yakut, Yekta Tüzün, Alparslan Kemal Tuzcu, Mithat Bahçeci, Senay Arikan, İrfan Soykan

.

DOI: 10.4236/ijcm.2011.23033                

Abstract

AIM: To determine the prevalence of celiac disease related autoantibodies in patients with type 1 and 2 diabetes mellitus (DM), and to compare these results with the general population. METHODS: In total, 137 consecutive patients with type 1 DM, 172 with type 2 DM and 113 age-sex matched control subjects were included into the study. Antigliadin-autoantibodies (AGA) IgG and IgA, and endomysial-antibodies(EMA) IgG and IgA antibodies were determined. Patients who were positive for one or more were offered a gastroduodenoscopic examination. RESULTS: AGA IgG positivity was detected in 38.7% (53/137) patients with type 1 DM in 26.2% (45/172) patients with type 2 DM and in 16.8% (19/113) control subjects (significant differences). AGA IgA positivity was detected in 24.8% (34/137) patients with type 1 DM, in 9.3% (16/172) patients with type 2 DM and in 3.5% (4/113) control subjects (significant differences). EMA IgG positivity was detected in 10.2% (14/137) patients with type 1 DM in 0.6% (1/176) patients with type 2 DM and 0.9% (1/113) control subjects (significant differences). EMA IgA positivity was detected in 11.7% (16/137) patients with type 1 DM in 0.6% (1/172) patients with type 2 DM and in none of control subjects. EMA IgA positivity was sig- nificantly higher in patients with type 1 DM as compared with patients with type 2 DM and controls. CONCLUSION: High prevalence of celiac disease at the diagnosis of type 1 DM is observed. Serological markers are useful for identifying celiac disease patients with type 1 DM.

Keywords

Celiac Disease, Diabetes Mellitus, AGA Ig A, AGA Ig G, EMA Ig A, EMA Ig G

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Farrell RJ, Kelly CP. Celiac sprue and refractory sprue.Fordtran and Sleisenger Gastrointestinal and liver disease. Vol. 2 pp. 2277-2306
[2]	Dirks M. Preventive health care, 2004 update: screening persons with insulin-dependent diabetes mellitus with se- rology for celiac disease: systematic review & recom- mendations. CMAJ.
[3]	Cruz JC, Rode EC , Gomez LS, et al. Celiac disease as- sociated antibodies in persons with latent autoimmune diabetes of adult and type 2 diabetes. Autoimmunity 2007 Mar; 40(2): 103-7
[4]	Catassi C, Fabiani E, R?tsch IM, Coppa GV, Giorgi PL, et al. The coeliac iceberg in Italy. A multicentre antigli- adin antibodies screening for coeliac disease in school- age subjects. Acta Paediatr Suppl. 1996 May; 412: 29-35
[5]	De Vitis I, Ghirlanda G, Gasbarrini G. Prevalence of coeliac disease in type I diabetes: a multicentre study. Acta Paediatr Suppl. 1996;412:56-57
[6]	Dieterich W, Ehnis T, Bauer M, et al. Identification of tissue transglutaminase as the autoantigen of celiac dis- ease. Nat Med. 1997; 3: 797-801
[7]	Logan RF, Rifkind EA, Turner ID, Ferguson A. Mortality in celiac disease. Gastroenterology. 1989; 97: 265-271
[8]	Lerner A, Lebenthal E. The controversy of the use of anti-gluten antibody (AGA) as a diagnostic tool in celiac disease. J Pediatr Gastroenterol Nutr. 1991; 12: 407-409
[9]	Ascher H, Hahn-Zoric M, Hansson L?, Kilander AF, Nilsson L?, Tlaskalova′ H. Value of serologic markers for clinical diagnosis and population studies of coeliac disease. Scand J Gastroenterol. 1996; 31: 61-67
[10]	Bürgin-Wolff A, Gaze H, Hadziselimovic F, et al. An- tigliadin and antiendomysium antibody determination for coeliac disease. Arch Dis Child. 1991; 66: 941-947
[11]	Farrell RJ, Kelly CP. Current concepts: celiac sprue . N Engl J Med 2002; 346:180-188.
[12]	Lorini R, Scaramuzza A, Vitali L, et el. Clinical aspects of coeliac disease in children with insulin-dependent dia- betes mellitus. J Pediatr Endocrinol Metab. 1996; 9: 101-111
[13]	Markku M, Pekka C. Celiac disease. Lancet 1997; 349: 1755-9.
[14]	Corazza GR, Biagi F, Andreani ML, et al. Screening test for celiac disease. Lancet 1997; 349: 325-6.
[15]	Corrao G, Corazza GR, Andreani ML, et al. Serological screening of celiac disease: Choosing the optimal pro- cedure according to various prevalence values. Gut 1994; 35: 771-5.
[16]	Sulkanen S, Halttunen T, Laurila K, et al. Tissue trans- glutaminase autoantibody enzyme-linked imunosorbent assay in detecting celiac disease. Gastroenterology 1998; 115: 132208.
[17]	Valdimarsson T, Franzen L, Grodzinsky E et al. Is small bowel biopsy necessary in adults with suspected celiac disease and IgA anti-endomysium antibodies? 100% positive predictive value for celiac disease in adults. Dig Dis Sci 1996; 41(1): 83087.
[18]	Rostom A, Dube C, Cranney A et al. Celiac disease. Evi- dence Report/Technology Assessment No. 104. AHRQ Publication No. 04-E029-2. Rockville, MD: Agency for Healthcare Research and Quality; 2004.
[19]	Sategna-Guidetti C, Pulitano R, Grosso S & Ferfoglia G. Serum IgA antiendomysium antibody titers as a marker of intestinal involvement and diet compliance in adult celiac sprue. J Clin Gastroenterol 1993; 17(2):123-127.
[20]	Talal AH, Murray JA, Goeken JA, et al. Celiac disease in adult population with insulin-dependent diabetes mellitus: Use of endomysial antibody testing. Am J Gastroenterol 1997; 92: 1280-4.
[21]	Rensch MJ, Merenich JA, Lieberman M, et al. Glu- ten-sensitive enteropathy in patients with insulin-dependent diabetes mellitus. Ann Intern Med 1996; 124: 564-7.
[22]	Carlsson AK, Axelsson IE, Borulf SK, et al. Prevalence of IgA-antiendomysium and IgA-antigliadin autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children and adolescents. Pediatrics 1999; 103: 1248-52.
[23]	Aygun C, Uraz S, Damci T, Osar Z, Yumuk V, Akdenizli E, Ilkova H. Celiac disease in an adult Turkish population with type 1 diabetes mellitus. Dig Dis Sci. 2005 Aug; 50(8): 1462-6.
[24]	Hummel M, Bonifacio E, Stern M, Dittler J, Schimmel A, Ziegler AG. Development of celiac disease-associated antibodies in offspring of parents with type I diabetes. Diabetologia. 2000; 43: 1005-1011
[25]	Holmes GKT. Long-term health risks for unrecognized coeliac patients. In: Auricchio S, Visakorpi JK, eds. Common Food Intolerance. I. Epidemiology of Coeliac Disease. Basel, Switzerland: Karger; 1992:105-118
[26]	West J, Logan RF, Smith CJ, Hubbard RB, Card TR. Malignancy and mortality in people with coeliac disease: population based cohort study. BMJ 2004; 329: 716-9.