High prevalence of celiac disease in Swedish children and adolescents with type 1 diabetes and the relation to the Swedish epidemic of celiac disease: a cohort study

Abstract

Aim. The aim was to determine the prevalence and clinical and temporal relationship of celiac disease (CD) in a population of Swedish children with type 1 diabetes mellitus (T1DM) before, during, and after the Swedish epidemic of CD (birth cohorts 1984–1996). Methods. Retrospective chart review between 1995 and 2005 was conducted of 1151 children (0–18 years old, born 1981–2004) with T1DM. Results. A prevalence of 9.1% (95% CI: 7.2–11.2) of CD in T1DM children was found. No significant difference in prevalence of CD was observed in different birth years, in contrast to the Swedish epidemic of CD. Sixty-two percent of children diagnosed with CD after T1DM onset had pathological levels of antibodies within the first 24 months. The presence or absence of gastrointestinal symptoms had no predictable value for biopsy-confirmed CD or not. Conclusion. The onset of CD in the T1DM population does not follow the pattern of the general population during the Swedish epidemic of CD. The shared genetic component in the human leukocyte antigen region in cases with comorbidity of CD and T1DM may overrule other CD-causing factors in the general population. Children with T1DM should be screened for CD at diagnosis and repeatedly at least during the first 2 years, even if asymptomatic.

Key Words::

• Celiac disease
• children
• prevalence
• screening
• type 1 diabetes mellitus

Acknowledgments

The authors thank Kerstin Elvin, PhD, MD at the Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, for her laboratory assistance, Per Näsman, PhD, Senior Statistician at the Royal Institute of Technology, for his help with the statistical analysis, and Assistant Professor Dr Hans Hildebrand for his valuable input.

Declaration of interest: All authors declare that they have no conflicting interest and no financial relationships relevant to this article to disclose. The present study was supported by grants from the Sigurd and Elsa Golje Foundation, Sällskapet Barnavård, Stiftelsen Samariten, and AstraZeneca, together with the Swedish Society for Gastroenterology.