Background In recent years, there has been significant change in the guidance for screening and confirmation of coeliac disease (CD) in patients with type 1 IDDM (Insulin Dependent Diabetes Mellitus). ISPAD (International Society for Paediatric and Adolescent Diabetes) Clinical Consensus Guidelines 2014 suggest screening of type 1 IDDM patients for CD at diagnosis with HLA DQ2/DQ8 and Immunoglobulin A tissue transglutaminase antibody (tTG-A). BSPGHAN (British Society of Paediatric Gastroenterology, Hepatology and Nutrition) guidelines 2013 provide clear pathway for confirmation of diagnosis of CD in symptomatic and asymptomatic patients.
Aim To evaluate practice of screening of type 1 IDDM patients for CD by diabetes team prior to referral to gastroenterology team and compliance with ESPGHAN/BSPGHAN guidance in confirmation of diagnosis of CD in these patients.
Methods Retrospective data collected from type 1 IDDM and coeliac databases over 5 year period (2011–2015). Retrospective reporting of gastrointestinal symptoms in gastroenterology clinic and method of confirmation of diagnosis of CD was noted to compare compliance with BSPGHAN guidance.
Results 12 patients (4 males and 8 females) with type 1 IDDM were diagnosed with CD with age range of 3–16 years (mean 9.75). All had screening with TTG at diagnosis of type 1 IDDM however HLA was not done on any patients. Referral to paediatric gastroenterology team was as per BSPGHAN guidance in all. Reporting of gastrointestinal symptoms increased from 3/12 in diabetic clinics to 8/12 in gastroenterology clinics. CD was confirmed by endoscopy in 5/12 (One transferred from other centre, one had TTG>3 times but <10 times UNL (upper normal limit) and 3 had raised tTG-A with no gastrointestinal symptoms. CD was confirmed by blood tests including HLA in 7/12 patients who were symptomatic and had TTG>10 times UNL.
Conclusion Screening of newly diagnosed patients with type 1 IDDM by diabetic team did not involve HLA testing. This could potentially avoid regular screening in minority of patients. There was significant increase in retrospective reporting of gastrointestinal symptoms in these patients when they attended with raised tTG-A suggesting possible subjective nature of the history. Diagnosis of CD was confirmed as per BSPGHAN guidelines with appropriate use of endoscopy where indicated. Based on this small study, we suggest survey for review of practice in other centres to assess compliance to current guidance by both Diabetes and gastroenterology teams.
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