Gastrointestinal Symptoms in Children With Type 1 Diabetes Screened for Celiac Disease

1494142172603PEDIATRICS Vol. 124 No. 3 September 2009, pp. e489-e495 (doi:10.1542/peds.2008-2434)


Gastrointestinal Symptoms in Children With Type 1 Diabetes Screened for Celiac Disease

Priya Narula, MD, MBBS, DNB, MRCPCHa, Lesley Porter, AMSPARb, Josephine Langton, MBChBa, Veena Rao, MBBS, DCH, MRCPCHa, Paul Davies, PhD, MSc, BScc, Carole Cummins, PhD, MSc, BAc, Jeremy Kirk, MD, FRCP, FRCPCHb, Timothy Barrett, PhD, MB, BS, MRCP, FRCPCH, DCHb and Susan Protheroe, MD, MBChB, FRCPCHa


a Departments of Gastroenterology
b Endocrinology
c Research and Development, Birmingham Children’s Hospital, Birmingham, United Kingdom

BACKGROUND: The association between celiac disease (CD) andtype 1 diabetes mellitus (DM) is recognized. Most cases of CDin patients with DM are reported to be asymptomatic.

OBJECTIVES: The objectives of this study were to (1) compareand audit our practice with the published standards for screeningfor CD in children with DM, (2) characterize the children withDM and biopsy-confirmed CD, in terms of growth and gastrointestinalsymptoms, and compare them with children with DM and negativeceliac serology, and (3) document the effects of a gluten-freediet (GFD) after 1 year of gastrointestinal symptoms, growth,and insulin requirement.

METHOD: We performed a retrospective case-note review of 22children with DM, positive celiac serology ± biopsy-confirmedCD, and 50 children with DM and negative celiac serology.

RESULTS: Twenty-two children (3.9% of the total diabetic population) had positive celiac serology on screening, with 17 (3%) having biopsy-confirmed CD. Ninety-four percent of the children had standardized celiac serology testing. At diagnosis of CD, 13 of the 17 biopsy-positive children (76.4%) had ≥1 gastrointestinal symptom. The frequency of gastrointestinal symptoms in negative celiac serology diabetic children was 6% (3 of 50) (P < .0005). Symptoms resolved in all children after introduction of a GFD. A significant improvement in weight SD score (P = .008) and BMI SD score (P = .02) was noted in those compliant with a GFDafter 1 year.

CONCLUSIONS: Children with DM and CD have a higher frequencyof gastrointestinal symptoms than their diabetic peers withnegative celiac serology and are not truly asymptomatic. Institutionof a GFD has a positive effect on nutritional status and symptomresolution in the short-term.


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