CLINICAL ASPECTS OF CELIAC-DISEASE IN CHILDREN WITH INSULIN-DEPENDENTDIABETES-MELLITUS

Coeliac disease (CD) is heterogeneous in its clinical presentation and pathological expression. Silent, latent and potential forms represent the submerged part of the so-called ''coeliac iceberg''. The associat ion of insulin-dependent diabetes mellitus (IDDM) and CD has been wide ly reported, For the screening of CD in diabetic patients, anti-reticu lin R1 (ARA-R1) and anti-endomysium (AEA) antibodies are more reliable markers than anti-gliadin (AGA) antibodies, Recent studies have repor ted an increased prevalence of CD in children with IDDM, In our experi ence intestinal biopsy confirmed a diagnosis of CD in 6 out of 172 dia betic patients, with a prevalence of 3.5%, Only occasionally does CD p recede the onset of IDDM; more often CD is diagnosed shortly ol someti mes years after the onset of diabetes, Typical gastrointestinal compla ints of CD (such as diarrhoea, abdominal distension) are rare in IDDM patients, while atypical isolated signs or symptoms of CD are more com mon, in particular sideropenic anemia, short stature, delayed puberty, epilepsy, hypertransaminasemia, dyspeptic symptoms, herpetiform derma titis, and recurrent aphthous stomatitis, It is recommended that all d iabetic children, even those asymptomatic, should be screened yearly f or CD, using a combination of AGA plus ARA-R1 and AEA.