Celiac disease is an autoimmune gastrointestinal disorder characterized by
mucosal atrophy of the jejunum on exposure to gluten, a protein found in gr
ains. The purpose of our study was to determine the prevalence of celiac di
sease in children with Downs syndrome in a U.S.-based Caucasian population.
The 97 Downs syndrome children were screened for celiac disease using seru
m IgA-anti-endomysial antibody testing, which is highly specific and sensit
ive for the disorder. Children with titers greater than 1:5 (using the IgA
endomysial antibody [EMA] test; EMA+) were considered affected. Ten childre
n (10.3%) were EMA+. We examined their HLA DQA1 DQB1 genotype, karyotype, c
linical characteristics, and the prevalence of celiac disease in their firs
t-degree relatives. The nine available karyotypes were trisomy 21. Downs sy
ndrome-specific mean height percentile was 64% +/- 269% (range <5-99%) and
weight percentile was 43% +/- 28% (range 5-95%). Presence of diarrhea, cons
tipation, vomiting, and abdominal pain was similar for children with and wi
thout celiac disease. Only bloating symptoms were significantly more freque
nt in those with celiac disease (EMA+). Seven of eight (88%) genotyped EMA children had the celiac disease-associated high-risk HLA DQA1*0501 DQB1*02
01 genotype as compared with 13/ 80 (16%) of EMA- children. Five of 48 (10%
) first-degree relatives of the celiac disease (EMA+) children were EMA+. I
n conclusion, celiac disease, as diagnosed by positive endomysial antibody
tests, has an increased prevalence in children with Downs syndrome in the U
.S. as compared with the general population (1/250). Clinical and growth ch
aracteristics do not distinguish between children with and without celiac d
isease. Based on these observations, it is recommended that children with D
owns syndrome be screened for celiac disease. Am. J. Med. Gen. 98:70-74, 20
01. (C) 2001 Wiley-Liss, Inc.