Celiac disease can be predicted by high levels of tissue transglutaminase antibodies in children and adolescents with type 1 diabetes

Abstract

Objectives: Children with type 1 diabetes (T1D) are not included in guidelines regarding diagnosis criteria for celiac disease (CD) without a diagnostic biopsy, due to lack of data. We explored whether tissue transglutaminase antibodies (anti-tTG) that were ≥ 10 times the upper limit of normal (10× ULN) predicted CD in T1D.

Methods: Data from the Swedish prospective Better Diabetes Diagnosis study was used, and 2035 children and adolescents with T1D diagnosed between 2005-2010 were included. Of these, 32 had been diagnosed with CD before T1D. The children without CD were repeatedly screened for CD using anti-tTG antibodies of immunoglobulin type A. In addition, their human leukocyte antigen (HLA) were genotyped. All children with positive anti-tTG were advised to undergo biopsy. Biopsies were performed on 119 children and graded using the Marsh-Oberhüber classification.

Results: All of the 60 children with anti-tTG ≥10x ULN had CD verified by biopsies. The degree of mucosal damage correlated with anti-tTG levels. Among 2003 screened children, 6.9% had positive anti-tTG and 5.6% were confirmed CD. The overall CD prevalence, when including the 32 children with CD before T1D, was 7.0% (145/2035). All but one of the children diagnosed with CD had HLA-DQ2 and/or DQ8.

Conclusions: As all screened children and adolescents with T1D with tissue transglutaminase antibodies above 10 times the positive value 10x ULN had CD, we propose that the guidelines for diagnosing CD in screened children, when biopsies can be omitted, should also apply to children and adolescents with T1D as a noninvasive method.

Keywords: biopsy; celiac disease; screening; tissue transglutaminase antibodies; type 1 diabetes.

FIGURE 1

Flowchart summarizing the diagnostic process of celiac disease (CD) in children with type 1 diabetes (T1D) with antibodies against tissue‐transglutaminase (anti‐tTG) and biopsies. The levels of anti‐tTG were given as under 10 times the upper limit of normal (<10x ULN) or equal and above 10 times this limit (≥10x ULN)

FIGURE 2

Degrees of mucosal damage in relation to antibodies against tissue‐transglutaminase (anti‐tTG) using the enzyme‐linked immuno assay (EliA) method. The lines represent the median. Levels of anti‐tTG correlated to the degree of mucosal damage

FIGURE 3

Degrees of mucosal damage in relation to antibodies against tissue‐transglutaminase (anti‐tTG) using the enzyme‐linked immunosorbent assay (ELISA) method. The lines represent the median. Levels of anti‐tTG correlated to the degree of mucosal damage