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Serum Immunoglobulin A Anti-Endomysial Antibody (IgA-EMA) and its Effectiveness in Screening for Celiac Disease in the Pediatric Population with Diabetes Mellitus 1

15 August 2009


INTRODUCTION: Diabetes Mellitus Type 1 (DM 1) and celiac disease (CD) are both autoimmune diseases that are associated with the human leukocyte antigen (HLA)-DQ2 and human leukocyte antigen (HLA)-DQ8 genetic halotypes. Different geographical areas vary with prevalence of CD in populations with DM 1, ranging from 1.1% to 16.4%. Type 1 diabetes is a chronic autoimmune disease and accounts for approximately two thirds of all new diagnoses of diabetes in patients 19 years of age and younger, with a continue rise in incidence. Celiac disease is also an autoimmune disorder, and is characterized by intestinal villous damage caused by gluten ingestion. In the United States and Western Europe, the prevalence is approximately 1%. Individuals are susceptible to celiac disease on average, within 10 years of their DM 1 diagnosis. The incidence of celiac disease is increasing in those with type 1 diabetes because screening for CD has been made possible with the availability of non-invasive serological testing. Immunoglobulin A anti-endomysial antibody (IgA- EMA) has high sensitivity and specificity for celiac disease and has been proven to be effective in diagnosing atypical and latent CD. However, the “gold” standard for celiac diagnosis is the intestinal biopsy.

METHODS: The focus of this study was to review the current literature on all studies pertaining to IgA-EMA screening for celiac disease in the pediatric population with type 1 diabetes. The studies involved screening of type 1 diabetic patients for celiac disease with IgA- EMA and intestinal biopsies for those who tested positive for IgA- EMA.

RESULTS: The seven studies showed high prevalence of celiac disease in pediatric individuals with type 1 diabetes. Several studies also demonstrated that those who were initially negative for celiac disease later developed latent celiac disease.

CONCLUSION: IgA-EMA is an effective screening test for celiac disease in individuals with type 1 diabetes. The studies reported that due to the high prevalence of celiac disease in conjunction with type 1 diabetes, initial screening for celiac disease at diabetes onset is recommended and should be performed. They also stated that since seroconversion could occur, and patients could develop latent celiac disease, screening for celiac disease should also be performed after diabetes onset. How often and at what interval screening should be done is unanswered.


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