CELIAC-DISEASE AND INSULIN-DEPENDENT DIABETES-MELLITUS - SCREENING INAN ADULT-POPULATION

We screened for celiac disease, by means of IgA class anti-endomysium antibodies (EmA), 383 consecutive adults with insulin-dependent diabet es mellitus (IDDM). Two control populations entered the study as well: 151 adults with biopsy proven celiac disease, as true positives; and 520 controls (healthy and diseased) as true negatives. IgA-EmA positiv ity was found in 145 of 151 (96%) celiac disease patients but in none of the controls (100% specificity). EmA were positive in 12 of 383 (3. 13%) IDDM patients: 10 of these positives underwent intestinal biopsy, which showed either partial or total villous atrophy. Only one patien t presented with gastrointestinal complaints, but severe iron deficien cy was found in all. The IDDM celiac patients were started on a gluten -free diet: four refused both the diet and the follow-up protocol. App roximately one year after gluten withdrawal no significant change in t he degree of diabetes control was observed, while an increased require ment for insulin was observed in three of four patients who strictly c omplied with the diet. The prevalence of biopsy-proven celiac disease among adult IDDM patients (1:38), eight times higher than that recentl y estimated for the general Italian population and the absence, except in one case, of gastrointestinal symptoms emphasizes the benefit of s creening programs on populations at risk.