Prevalence of celiac disease in Brazilian children and adolescents with type 1 diabetes mellitus

Objective: A previously unrecognized high prevalence of celiac disease (CD) has been found by screening among European and North American patients with type I diabetes mellitus (DM 1). The prevalence of CD among Brazilian children with DM I is not known. This study was conducted to determine the prevalence of CD in Brazilian children and adolescents with DM 1. Methods: One hundred and four children and adolescents with DM 1 (52 males and 52 females; age range 22 months - 19 years) and 105 age and gender-matched control participants were screened for CD using the IgA antiendomysial antibody test (IgA-EmA) and total serum IgA. A small bowel biopsy was performed in all patients with positive IgA-EmA. Results: Nine of 104 diabetic patients (8.7%) had a positive IgA-EmA. Biopsies were normal in four patients, two had partial or subtotal villous atrophy with elevated intraepithelial lymphocyte (IEL) Counts, and three showed partial villous atrophy but with IEL counts under the maximum limit adopted (40 IEL/100 enterocytes). EmA-IgA positive patients had mild, non-specific gastrointestinal complaints including dyspepsia, abdominal pain, flatulence and constipation. All control participants had negative results for IgA-EmA. Conclusion: The prevalence of CD in a group of Brazilian pediatric DM I patients was at least 4.8%, a prevalence comparable to European and North American studies. The high prevalence of CD among DM I emphasizes the need for routine screening in all countries including Brazil.