Anthropometric, serologic, and laboratory correlation with villous blunting in pediatric celiac disease: diabetics are different.

OBJECTIVES

We evaluated the correlation between level of tissue transglutaminase (TTG) and endomysial antibodies (EMAs) to different degrees of intestinal damage in celiac disease (CD) children with [presence of diabetes mellitus (DM)+] and without [absence of diabetes mellitus (DM-)] type I diabetes. We also assessed the correlation between albumin, hemoglobin (hgb), transaminases, symptom presence, age of cereal introduction, and body mass index (BMI) to different degrees of intestinal damage.

METHODS

Retrospective review of patients seen at the Children's Hospital of Philadelphia between January 2002 and June 2006 revealed 60 children (mean age 9.8 y) who had TTG, EMA, and other laboratory tests performed at time of histologic CD diagnosis from duodenal biopsies. Twenty-one of 60 children had DM. All children were stratified for histologic damage according to Marsh classification.

RESULTS

Overall, Marsh (M) I lesions were seen in 2 (3.3%), MII in 2 (3.3%), IIIa in 14 (23.3%), IIIb in 15 (25%), and IIIc in 27 (45%); no differences in DM- versus DM+ groups. TTG was positive in all and EMA was positive in all but 1 child. Among DM- and DM+ children, median TTG and EMA values were higher with MIIIa-c, respectively. For DM-, BMI percentile, hgb, and mean corpuscular volume were lower with advancing histology. However, in DM+, no significant correlation of BMI percentile, hgb, or mean corpuscular volume with grade was observed. Cereal introduction age, hypoalbuminemia, and hepatitis did not differ between MIIIa-c in any group.

CONCLUSIONS

TTG and EMA mean serum values are higher in CD children with severe enteropathy (MIIIc) than in those with mild enteropathy (MIIIa). CD in DM is accompanied by serologic and histologic findings identical to that of a non-DM CD population. As CD is identified through screening in DM, it is often silent and not associated with symptoms, growth abnormalities, or anemia. Clinical parameters (height, weight, hgb, symptoms) are not helpful in identifying silent CD in DM.