ASSOCIATION OF AUTOIMMUNE DISEASES IN CHILDREN WITH CELIAC DISEASE: A SINGLE-CENTER PROSPECTIVE OBSERVATIONAL STUDY

Abstract

BACKGROUND
Celiac disease is an immune mediated chronic systemic disease characterised by intestinal mucosal damage in response to dietary gluten, among genetically predisposed individuals. There is a recognised association between celiac disease and a variety of other autoimmune diseases (AIDs). There are studies available about association of AIDs with celiac disease in adults, but there is paucity of literature for children. No reports regarding AIDs associated with celiac disease are available in literature for Indian pediatric population.
METHODS - The study included 90 children (aged 1–18 years) with celiac disease who were diagnosed and followed up at our tertiary care center. All AIDs that accompanied celiac disease were recorded and their association was analysed.

RESULTS- Mean age of celiac disease patients was 7.69 ±3.79 years (age range:1-18 ). Among them, 47 (52.2%) were boys and 43 (47.8%) were girls (male:female ratio-1.09 : 1). Among the 90 patients with celiac disease, 40 (44.4%) were found to have associated AIDs. The common AIDs were Type 1 diabetes mellitus (40%), autoimmune hypothyroidism (12.5%), autoimmune hemolytic anaemia (10%), autoimmune hepatitis (5%) and dermatitis herpeteformis (5%). Other less common diseases were grave's disease (2.5%), rheumatoid arthritis (2.5%) and vitiligo (2.5%). Direct Coombs test was positive in 12.5% of patients with ADs (p = 0.035). Laboratory analysis showed DCT positivity , higher HbA1C and high random blood sugar levels in celiac disease patients correlated significantly with presence of AIDs (p < 0.001).
CONCLUSION - A better knowledge of clinical profile of celiac disease patients and associated immune mediated disorders will provide a better diagnostic efficacy. This will be helpful in avoiding unnecessary hardships of parents and improving overall well being of children.