SEROCONVERSION OF RETICULIN AUTOANTIBODIES PREDICTS CELIAC-DISEASE ININSULIN-DEPENDENT DIABETES-MELLITUS

Serum IgA class reticulin autoantibody test was performed prospectivel y once a year on 238 children and adolescents with insulin dependent d iabetes mellitus (IDDM). At the initial testing, within one year after onset of IDDM, five were positive and 233 were negative. During follo w up a further 11 of the initially antibody negative children became p ositive (6.7%). Jejunal biopsy was performed at the appearance of the autoantibodies and silent coeliac disease was shown in nine (3.8%). On e of these children showed on initial biopsy after the onset of IDDM t o have normal jejunal mucosal architecture deteriorating later to a fl at lesion. Jejunal immunohistochemical studies of another of the patie nts positive for reticulin autoantibodies but normal on routine biopsy showed an increased density of intraepithelially located gamma/delta T cells and aberrant HLA-DR expression in the crypts pointing to ongoi ng mucosal inflammation and potential coeliac disease. This study show s that in IDDM patients, reticulin autoantibody negative subjects beco me antibody positive, which may be followed by coeliac disease. Repeat ed serological screening and rebiopsy should be considered to detect l ate developing clinically silent coeliac disease among patients with I DDM.