CELIAC-DISEASE IN PATIENTS WITH DIABETES- MELLITUS - VALUE OF ANTIGLIADIN, ANTIRETICULIN, AND ANTIENDOMYSIUM ANTIBODIES

Antibodies to gliadin (AGA), reticulin (ARA), and endomysium (AEA) wer e looked for prospectively in 86 children (mean age, 13 y 2 mo; range 3 to 22 y) with insulin-dependent diabetes mellitus to identify patien ts with celiac disease. Six patients had moderate, isolated, nonsignif icant abnormalities in AGA titers. Elevated titers of all three antibo dies were found in four patients; three of these patients had a flat m ucosa on biopsy specimens, and the fourth declined intestinal biopsy. The three patients with documented celiac disease had clinical and/or laboratory test abnormalities, with one case each of chronic diarrhea with failure to gain weight, iron deficiency, and failure to gain heig ht. These abnormalities resolved under a gluten-free diet. The immunol ogic markers for celiac disease are helpful for detecting this conditi on in insulin-dependent diabetics, who often have minimal symptoms. Al though the gluten-free diet is undoubtedly effective on the gastrointe stinal and growth disorders, its effect on glycemic control is less cl ear.