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Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study.
J Gastroenterol Hepatol 2019; 34(4):673-678JG

Abstract

BACKGROUND AND AIM

The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa.

METHODS

This was a cross-sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), and anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification.

RESULTS

Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively.

CONCLUSION

The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus.

Authors+Show Affiliations

Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.Department of Gastroenterology and Hepatology, University of KwaZulu-Natal, Durban, South Africa.Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.Department of Anatomical Pathology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

30600564

Citation

Paruk, Imran M., et al. "Prevalence and Characteristics of Celiac Disease in South African Patients With Type 1 Diabetes Mellitus: Results From the Durban Diabetes and Celiac Disease Study." Journal of Gastroenterology and Hepatology, vol. 34, no. 4, 2019, pp. 673-678.
Paruk IM, Naidoo VG, Pirie FJ, et al. Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study. J Gastroenterol Hepatol. 2019;34(4):673-678.
Paruk, I. M., Naidoo, V. G., Pirie, F. J., Maharaj, S., Nkwanyana, N. M., Dinnematin, H. L., ... Motala, A. A. (2019). Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study. Journal of Gastroenterology and Hepatology, 34(4), pp. 673-678. doi:10.1111/jgh.14596.
Paruk IM, et al. Prevalence and Characteristics of Celiac Disease in South African Patients With Type 1 Diabetes Mellitus: Results From the Durban Diabetes and Celiac Disease Study. J Gastroenterol Hepatol. 2019;34(4):673-678. PubMed PMID: 30600564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study. AU - Paruk,Imran M, AU - Naidoo,Vasudevan G, AU - Pirie,Fraser J, AU - Maharaj,Sureka, AU - Nkwanyana,Ntombifikile M, AU - Dinnematin,Hilary L, AU - Ganie,Yasmeen, AU - Ramdial,Pratistadevi K, AU - Motala,Ayesha A, Y1 - 2019/01/31/ PY - 2018/09/18/received PY - 2018/12/20/revised PY - 2018/12/25/accepted PY - 2019/1/3/pubmed PY - 2019/1/3/medline PY - 2019/1/3/entrez KW - South Africa KW - celiac antibodies KW - celiac disease KW - type 1 diabetes mellitus SP - 673 EP - 678 JF - Journal of gastroenterology and hepatology JO - J. Gastroenterol. Hepatol. VL - 34 IS - 4 N2 - BACKGROUND AND AIM: The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa. METHODS: This was a cross-sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), and anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification. RESULTS: Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively. CONCLUSION: The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/30600564/Prevalence_and_characteristics_of_celiac_disease_in_South_African_patients_with_type_1_diabetes_mellitus:_Results_from_the_Durban_Diabetes_and_Celiac_Disease_Study_ L2 - https://doi.org/10.1111/jgh.14596 DB - PRIME DP - Unbound Medicine ER -