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High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study.
BMC Gastroenterol 2012; 12:180BG

Abstract

BACKGROUND

There is lack of data on prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) in Arabs in the Middle East. The present investigation aims to study the prevalence rate and clinical characteristics of CD among Saudi children with T1D using a combination of the most sensitive and specific screening serologic tests (anti- tissue transglutaminase antibodies IgA [anti-TTG] and ednomyseal antibodies [EMA]) and to determine the lower cut-off value of anti- anti-TTG level that best predicts CD in children with T1D.

METHODS

Children with T1D following in diabetic clinic have been prospectively screened for presence of CD, over a two-year period (2008-2010), by doing anti-TTG, EMA, and total IgA. Children with positive anti-TTG titres (>50 U/ml) and/or EMA and children with persistently low positive anti-TTG titres (two readings 20-50 U/ml; within 6 months intervals) had upper endoscopy and 6 duodenal biopsies.

RESULTS

One hundred and six children with T1D have been screened for CD: age ranged between 8 months to 15.5 years (62 females). Nineteen children had positive anti-TTG and/or EMA, however only 12 children had biopsy proven CD (11.3%). Five of 12 had gastrointestinal symptoms (42%). Children with T1D and CD had significantly lower serum iron than children with T1D alone (8.5 μgm/L Vs 12.5 μgm/L; P = 0.014). The sensitivity and specificity of anti-TTG were 91.6% and 93.6%, with a positive and negative predictive value of 64.7% and 98.8%, respectively. Receiver operated characteristics analysis for the best cut-off value of anti-TTG level for diagnosis of CD was 63 units (sensitivity 100% and specificity 98.8%).

CONCLUSION

CD is highly prevalent among Saudi children with T1D. Anti-TTG titres more than 3 times the upper limit of normal has very high sensitivity and specificity for diagnosis of CD in T1D children.

Authors+Show Affiliations

Department of Pediatrics at Children's Hospital, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. aa_alhussaini@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23259699

Citation

Al-Hussaini, Abdulrahman, et al. "High Prevalence of Celiac Disease Among Saudi Children With Type 1 Diabetes: a Prospective Cross-sectional Study." BMC Gastroenterology, vol. 12, 2012, p. 180.
Al-Hussaini A, Sulaiman N, Al-Zahrani M, et al. High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study. BMC Gastroenterol. 2012;12:180.
Al-Hussaini, A., Sulaiman, N., Al-Zahrani, M., Alenizi, A., & El Haj, I. (2012). High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study. BMC Gastroenterology, 12, p. 180. doi:10.1186/1471-230X-12-180.
Al-Hussaini A, et al. High Prevalence of Celiac Disease Among Saudi Children With Type 1 Diabetes: a Prospective Cross-sectional Study. BMC Gastroenterol. 2012 Dec 23;12:180. PubMed PMID: 23259699.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High prevalence of celiac disease among Saudi children with type 1 diabetes: a prospective cross-sectional study. AU - Al-Hussaini,Abdulrahman, AU - Sulaiman,Nimer, AU - Al-Zahrani,Musa, AU - Alenizi,Ahmed, AU - El Haj,Imad, Y1 - 2012/12/23/ PY - 2012/06/27/received PY - 2012/12/19/accepted PY - 2012/12/25/entrez PY - 2012/12/25/pubmed PY - 2013/6/15/medline SP - 180 EP - 180 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 12 N2 - BACKGROUND: There is lack of data on prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) in Arabs in the Middle East. The present investigation aims to study the prevalence rate and clinical characteristics of CD among Saudi children with T1D using a combination of the most sensitive and specific screening serologic tests (anti- tissue transglutaminase antibodies IgA [anti-TTG] and ednomyseal antibodies [EMA]) and to determine the lower cut-off value of anti- anti-TTG level that best predicts CD in children with T1D. METHODS: Children with T1D following in diabetic clinic have been prospectively screened for presence of CD, over a two-year period (2008-2010), by doing anti-TTG, EMA, and total IgA. Children with positive anti-TTG titres (>50 U/ml) and/or EMA and children with persistently low positive anti-TTG titres (two readings 20-50 U/ml; within 6 months intervals) had upper endoscopy and 6 duodenal biopsies. RESULTS: One hundred and six children with T1D have been screened for CD: age ranged between 8 months to 15.5 years (62 females). Nineteen children had positive anti-TTG and/or EMA, however only 12 children had biopsy proven CD (11.3%). Five of 12 had gastrointestinal symptoms (42%). Children with T1D and CD had significantly lower serum iron than children with T1D alone (8.5 μgm/L Vs 12.5 μgm/L; P = 0.014). The sensitivity and specificity of anti-TTG were 91.6% and 93.6%, with a positive and negative predictive value of 64.7% and 98.8%, respectively. Receiver operated characteristics analysis for the best cut-off value of anti-TTG level for diagnosis of CD was 63 units (sensitivity 100% and specificity 98.8%). CONCLUSION: CD is highly prevalent among Saudi children with T1D. Anti-TTG titres more than 3 times the upper limit of normal has very high sensitivity and specificity for diagnosis of CD in T1D children. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/23259699/High_prevalence_of_celiac_disease_among_Saudi_children_with_type_1_diabetes:_a_prospective_cross_sectional_study_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-12-180 DB - PRIME DP - Unbound Medicine ER -