CELIAC-DISEASE IN CHILDREN AND ADOLESCENT WITH IDDM - CLINICAL CHARACTERISTICS AND RESPONSE TO GLUTEN-FREE DIET

A total of 167 children and adolescents with insulin-dependent (Type 1 ) diabetes mellitus (97 males; age range 1.9-22.4 yrs) in a UK paediat ric diabetic clinic were screened for coeliac disease using the IgA en domysial (EMA) test, or, in IgA deficient subjects, the IgG antigliadi n (AGA) test. Antibody positive subjects were selected for small bowel biopsy, and confirmed coeliac cases started on a gluten free diet. Cl inical features, height (Mt) standard deviation score (SDS), body mass index (BMI) SDS, HbA(1c), insulin requirements' haemoglobin (Mb), mea n red cell volume (MCV), serum folate and ferritin levels were evaluat ed at diagnosis and thereafter at 3-6 month intervals. A total of 156 subjects (93.4 %) were antibody negative. Eleven (6.6 %) were antibody positive (10 EMA/1 AGA; 6 males), of whom 9 had biopsies: 1 normal: 8 coeliac (4.8 %; 5 males; 1 'classical'; 1 anaemia; 3 'atypical'; 3 as ymptomatic). Seven coeliac subjects were followed during 12-24 months of dietary therapy. Pretreatment mean (range) Mt SDS = 0.08 (-1.66 to 1.88); BMI SDS = 0.32 (-0.82 to 1.29); HbA(1c) = 8.9 (6.2 to 11.3 %); insulin dose = 0.98 (0.51 to 1.29) U kg(-1) day(-1), During treatment antibody status reverted to and remained negative, and symptoms resolv ed, By 24 months, there was a trend towards increased BMI SDS (mean (r ange) 1.31 (0.47 to 2.29), p = 0.248) and to reductions in HbA(1c) (8. 1 (6.4-10.8), p = 0.697). Repeat small bowel biopsies were normal in 6 subjects (1 refused). No statistically significant changes occurred i n any other parameters. In conclusion, serological screening is effect ive, although the therapeutic benefit of dietary therapy in asymptomat ic cases remains uncertain. (C) 1998 John Wiley & Sons, Ltd.