The Saudi Journal of Gastroenterology (Jan 2023)

Frequency and predictive factors for spontaneous normalization of anti-tissue transglutaminase-IgA serology among Saudi children with type 1 diabetes mellitus: A cohort study

  • Ahmed Al Sarkhy,
  • Ali Al Hassan,
  • Heba Assiri,
  • Hayfa Alabdulkarim,
  • Noor AlAnazi,
  • Nawaf Alshammari,
  • Najla AlOtaibi,
  • Mona Al Asmi,
  • Asaad Assiri,
  • Reem Al-Khalifah,
  • Shaik Shaffi Ahamed,
  • Mohammad El Mouzan

DOI
https://doi.org/10.4103/sjg.sjg_25_23
Journal volume & issue
Vol. 29, no. 5
pp. 278 – 285

Abstract

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Background: Celiac serology can be transiently elevated in patients with type 1 diabetes mellitus (T1DM) and normalized despite gluten consumption. This study aimed to identify the frequency and predictive factors of spontaneous normalization of anti-tissue transglutaminase (anti-TTG-IgA) antibodies in these patients. Methods: The charts of all patients (≤18 years) with T1DM were retrospectively reviewed from 2012 to 2021 at a tertiary care center in Riyadh, Saudi Arabia. The following data were collected: clinical characteristics of the participants, anti-TTG-IgA-immunoglobulin (Ig) A antibody, and histological findings. The outcome of positive anti-TTG-IgA-IgA in patients with T1DM and the predictive factors for spontaneous normalization were investigated. Results: Of the 1,006 patients with T1DM, 138 (13.7%) had elevated anti-TTG-IgA antibodies, celiac disease was diagnosed in 58/138 (42%) patients, spontaneous normalization of anti-TTG-IgA was observed in 65 (47.1%) patients, and fluctuating anti-TTG-IgA antibodies were seen in 15 (10.9%) patients. The patients with anti-TTG-IgA levels at 3–10 times the upper normal limits (UNL), and those with levels ≥10 times UNL were less likely to have spontaneous normalization of anti-TTG-IgA compared to patients with levels at 1–3 times UNL (hazard ratio [HR] = 0.28, 95% confidence interval [Cl] = 0.13–0.61, P = 0.001, and HR = 0.03, 95% Cl = 0.00–0.19, P < 0.001, respectively). Conclusion: Asymptomatic patients with T1DM with mild elevation of anti-TTG-IgA need not be rushed for invasive endoscopy or exposed to an un-needed gluten-free diet but should rather have a regular follow-up of their celiac serology.

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