Prospective antibody case finding of coeliac disease in type-1 diabetes children: need of biopsy revisited
Article first published online: 4 JAN 2013
©2012 The Author(s)/Acta Pædiatrica ©2012 Foundation Acta Pædiatrica
Volume 102, Issue 3, pages e102–e106, March 2013
How to Cite
Popp, A., Mihu, M., Munteanu, M., Ene, A., Dutescu, M., Colcer, F., Raducanu, D., Laurila, K., Anca, I. and Mäki, M. (2013), Prospective antibody case finding of coeliac disease in type-1 diabetes children: need of biopsy revisited. Acta Paediatrica, 102: e102–e106. doi: 10.1111/apa.12117
- Issue published online: 5 FEB 2013
- Article first published online: 4 JAN 2013
- Accepted manuscript online: 4 DEC 2012 10:00AM EST
- Manuscript Accepted: 30 NOV 2012
- Manuscript Revised: 26 NOV 2012
- Manuscript Received: 29 OCT 2012
- Case finding;
- Coeliac disease;
- Diagnostic criteria;
- Type 1 diabetes
To evaluate whether coeliac disease (CD) can be diagnosed by measuring autoantibodies without small-intestinal mucosal biopsies in children with type 1 diabetes.
Case finding of CD was undertaken in 181 consecutive IgA-competent children with type 1 diabetes using transglutaminase 2 (TG2) and endomysial IgA antibody (EMA) tests in serum and the rapid point of care test in fingertip whole-blood sample. Endoscopy with intestinal biopsies was recommended for patients with high TG2-IgA titres (>96 U) and in children with lower positive tests if either the EMA test or the rapid point of care test was additionally positive. The duodenal mucosal biopsies were graded according to the Marsh classification.
The TG2-IgA test had a 15.5% and the EMA test a 6.0% seropositivity. All seven biopsied high-titre TG2-IgA-positive children were symptom free and found to have CD (Marsh 3 type lesion). These patients were also positive for EMA and in the rapid point of care test. Lower titre TG2-IgA-positive children had histological Marsh 1 to 3a lesions.
None of the type 1 diabetes children with high TG2-IgA titres would have needed endoscopy with duodenal biopsies to reach a CD diagnosis. Lower TG2-IgA-positive patients need to be biopsied.