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J Gastroenterol Hepatol. 2019 Jan 1. doi: 10.1111/jgh.14596. [Epub ahead of print]

Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study.

Author information

1
Department of Diabetes and Endocrinology.
2
Gastroenterology and Hepatology.
3
Public Health Medicine, University of KwaZulu-Natal.
4
Department of Haematology.
5
Paediatrics.
6
Anatomical Pathology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.

Abstract

AIMS:

To assess the prevalence and characteristics of CD in all patients with Type 1 diabetes mellitus (T1DM) attending a tertiary adult diabetes clinic in Durban, South Africa.

METHODS:

This was a cross-sectional observational study which screened 202 patients; of these 56.4% were African (black), 31.7% Asian Indian, 4.5% White and 7.4% mixed race. Demographic data, symptoms and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy was performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification.

RESULTS:

Mean age and mean duration of diabetes was 26.4±11.4 and 10.7±9.1 years respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG IgA 8.4%, tTG IgG 1.9%, AGA IgA 18.3% and AGA IgG 21.8%. Histologic evidence of CD was found in 5.9% (n:12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively.

CONCLUSION:

The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibody was poor and merit further evaluation as screening tools for CD in South African patients with T1DM.

KEYWORDS:

South Africa; celiac antibodies; celiac disease; type 1 diabetes mellitus

PMID:
30600564
DOI:
10.1111/jgh.14596

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