Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report

It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagn...

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Vydané v:	Journal of clinical research in pediatric endocrinology Ročník 14; číslo 1; s. 1 - 9
Hlavní autori:	Hatun, Şükrü, Dalgıç, Buket, Gökşen, Damla, Aydogdu, Sema, Savaş Erdeve, Şenay, Kuloğlu, Zarife, Doğan, Yaşar, Aycan, Zehra, Yeşiltepe Mutlu, Gül, Uslu Kızılkan, Nuray, Keser, Alev, Beşer, Ömer Faruk, Özbek, Mehmet Nuri, Bideci, Aysun, Ertem, Deniz, Evliyaoğlu, Olcay, Eliuz Tipici, Beyza, Gökçe, Tuğba, Muradoğlu, Serra, Taşkın, Orhun Çığ, Koca, Tuğba, Tütüncüler, Filiz, Baş, Firdevs, Darendeliler, Feyza, Selimoğlu, Mukadder Ayşe
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	Turkey Galenos Yayinevi Tic. Ltd 01.03.2022 Galenos Publishing Pediatric Endocrinology and Diabetes Society
Predmet:	anti-tissue transglutaminase-iga Autoantibodies Celiac disease Celiac Disease - complications Celiac Disease - diagnosis Child children Clinical Decision-Making Complications and side effects Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - diagnosis Diagnosis Health aspects Humans Immunoglobulin A Measurement Pediatric research Review Risk factors Transglutaminases Type 1 diabetes Turkey Celiac disease type 1 diabetes Children anti-tissue transglutaminase-IgA
ISSN:	1308-5727, 1308-5735, 1308-5735
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Abstract	It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.
AbstractList	It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients' families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors' own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD. It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients' families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors' own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD. Keywords: Children, type 1 diabetes, Celiac disease, anti-tissue transglutaminase-IgA It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.It is well-known that in children with type 1 diabetes (T1D), the frequency of Celiac disease (CD) is increased due to mechanisms which are not fully elucidated but include autoimmune injury as well as shared genetic predisposition. Although histopathologic examination is the gold standard for diagnosis, avoiding unnecessary endoscopy is crucial. Therefore, for both clinicians and patients’ families, the diagnosis of CD remains challenging. In light of this, a joint working group, the Type 1 Diabetes and Celiac Disease Joint Working Group, was convened, with the aim of reporting institutional data and reviewing current international guidelines, in order to provide a framework for clinicians. Several controversial issues were discussed: For CD screening in children with T1D, regardless of age, it is recommended to measure tissue transglutaminase-immunoglobulin A (tTG-IgA) and/or endomysial-IgA antibody due to their high sensitivity and specificity. However, the decision-making process based on tTG-IgA titer in children with T1D is still debated, since tTG-IgA titers may fluctuate in children with T1D. Moreover, seronegativity may occur spontaneously. The authors’ own data showed that most of the cases who have biopsy-proven CD had tTG-IgA levels 7-10 times above the upper limit. The decision for endoscopy based solely on tTG-IgA levels should be avoided, except in cases where tTG-IgA levels are seven times and above the upper limit. A closer collaboration should be built between divisions of pediatric endocrinology and gastroenterology in terms of screening, diagnosis and follow-up of children with T1D and suspicious CD.
Audience	Academic
Author	Beşer, Ömer Faruk Dalgıç, Buket Tütüncüler, Filiz Gökşen, Damla Eliuz Tipici, Beyza Aydogdu, Sema Savaş Erdeve, Şenay Uslu Kızılkan, Nuray Gökçe, Tuğba Kuloğlu, Zarife Aycan, Zehra Keser, Alev Hatun, Şükrü Yeşiltepe Mutlu, Gül Darendeliler, Feyza Ertem, Deniz Koca, Tuğba Selimoğlu, Mukadder Ayşe Taşkın, Orhun Çığ Özbek, Mehmet Nuri Doğan, Yaşar Bideci, Aysun Evliyaoğlu, Olcay Baş, Firdevs Muradoğlu, Serra
AuthorAffiliation	9 Koç University Hospital, Department of Pediatric Gastroenterology, İstanbul, Turkey 15 İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İstanbul, Turkey 7 Fırat University Faculty of Medicine, Department of Pediatric Gastroenterology, Elazığ, Turkey 8 Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey 11 İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology, and Nutrition, İstanbul, Turkey 16 İstanbul University, İstanbul Faculty of Medicine, Department of Nutrition and Dietetics, İstanbul, Turkey 17 Koç University Faculty of Medicine, Department of Pathology, İstanbul, Turkey 21 Memorial Ataşehir/Bahçelievler Hospitals, Clinic of Pediatric Gastroenterology, Hepatology and Nutrition, İstanbul, Turkey 5 University of Health Sciences Turkey, Ankara Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training an
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References	Barr (ref0) 2017; 189 Goodman (ref1) 2018
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SubjectTerms	anti-tissue transglutaminase-iga Autoantibodies Celiac disease Celiac Disease - complications Celiac Disease - diagnosis Child children Clinical Decision-Making Complications and side effects Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - diagnosis Diagnosis Health aspects Humans Immunoglobulin A Measurement Pediatric research Review Risk factors Transglutaminases Type 1 diabetes
Title	Recommendations for Clinical Decision-making in Children with Type 1 Diabetes and Celiac Disease: Type 1 Diabetes and Celiac Disease Joint Working Group Report
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