Diagnosing celiac disease (CeD) in children with type 1 diabetes mellitus (T1DM) currently demands serology and duodenal biopsies. The non-biopsy approach relying on high tissue transglutaminase IgA antibodies (TGA) and, in an independent sample positive endomysial IgA antibodies (EMA), as performed in children without diabetes, is advocated and practiced by caregivers. This systematic review investigates the current evidence for this approach in children with T1DM.
PubMed, Embase.com, Cochrane Database of Systematic Reviews/Wiley, Cochrane Central Register of Controlled Trials/Wiley, Web of Science/Clarivate Analytics and Scopus were searched (until December 2023). Inclusion criteria were full-text English articles reporting original data on serology and histology of CeD in pediatric T1DM patients. Studies providing combined data of CeD serology and histology in children with T1DM were included. The overall prevalence of CeD in children with T1DM, the percentage of children with TGA ≥10xULN, EMA (if available) and the histological outcome in these children was extracted.
3674 unique studies were identified. After title and abstract screening, 260 studies were reviewed in full text. Seventeen articles were included in this systematic review, providing data on 9279 children with positive TGA. In 8 studies, information was available from 194 T1DM-children with TGA≥10xULN and adequately performed histology. The sensitivity of TGA ≥ 10×ULN for detecting histological changes consistent with celiac disease (Marsh > 2) was 95.4% (185/194 cases).
The available evidence is too limited to support a non-biopsy approach in children with T1DM; prospective studies are needed.
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