Original articlePrevalence and clinical features of celiac disease in 950 children with type 1 diabetes in FrancePrévalence et présentation clinique en France de la maladie cœliaque chez 950 enfants atteints de diabète de type 1
Section snippets
Patients and methods
We retrospectively studied a vast cohort of children with type 1 DM. Charts of all patients (n = 950) receiving follow-up for type 1 DM at the pediatric diabetology Department of the Robert Debre University Hospital in Paris, France, between January 1, 1994, and December 31, 2001, were studied. We excluded patients with all other forms of diabetes. Routine screening for celiac disease antibodies in type 1 DM was introduced in 1994 in our department and performed in the same laboratory throughout
Prevalence
Of the 950 children with type 1 DM in the study cohort, 15 (ten girls and five boys) had histologically documented celiac disease, yielding a prevalence of 1.6%. Villous atrophy was total in nine of them and subtotal in six.
Of the 15 cases of celiac disease, 14 were diagnosed after the introduction of routine screening for specific antibodies. In one case, the diagnosis of celiac disease was made, before 1994, upon evaluation of symptoms.
Characteristics of the 15 patients at diagnosis of celiac disease
Mean age (± SD) at diagnosis of type 1 DM was 6 ± 4.2 years
Seroconversion
This was documented in two patients (cases #1 and #3). Antibodies specific for celiac disease was initially negative, but became positive during follow-up. One of these patients (case #1) was a girl of Portuguese descent with an unremarkable family history. Type 1 DM was diagnosed when she was 13 months old and, at the time, all screening tests for celiac disease were negative. One year later, low titers of antigliadin antibodies were found (IgA AGA, 22 IU; IgG AGA, 23 IU). At 3 years of age,
Discussion
We evaluated the prevalence of celiac disease on the basis of histology rather than positive antibody markers in a cohort of 950 children followed-up for type 1 DM. This is the largest type 1 DM paediatric population studied in France. The prevalence of celiac disease was 1.6%, 40 times higher than its prevalence in the general French pediatric population (0.41/1000) [13]. However, only symptomatic forms are included in prevalence studies among the general population. In fact, the prevalence of
Acknowledgments
We thank all the pediatric dietitians and gastroenterologists (Professor J.P. Cezard and Professor J.P. Hugot) who managed the children followed-up at the Robert Debré Hospital; Professor Peuchmaur and Professor Sterkers for the histopathology and immunogenetic tests; and the Association des Juniors en Pédiatrie and Gallia for helping to edit the manuscript.
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