Our daughter, age 8, has had diabetes since 2, and asthma since 4. She was just diagnosed as being hypothyroid, and is doing well on 0.050�mg of Synthroid [a brand name of thyroid hormone]. She has had severe stomach aches and headaches for the past 2 months. We have now seen a pediatric gastroenterologist, who suspects celiac disease. We are awaiting blood test results. I have been looking into celiac disease on the web, and do not find much pediatric information. Can you please help me?

Celiac disease is an autoimmune disorder of the lining cells of the upper small bowel which results in an extreme sensitivity to the wheat protein gluten. In the fully developed condition, the signs are impaired growth, a distended abdomen and a chronic fatty diarrhoea; but in diabetic children there may be no more than intermittent abdominal pain or even just poor control. The treatment is to restrict wheat in the diet. Up to 10% of Type�1A (autoimmune) diabetics have the celiac syndrome and this grouping of autoimmune problems particularly with hypothyroidism has come to be known as the Autoimmune Polyglandular Syndrome Type II. The specific test is for anti-transglutaminase antibodies in the serum. Another much less common condition which may also be associated is that of adrenal gland insufficiency and here the test is for anti-21hydroxylase antibodies; it might be worth asking your daughter’s doctor about getting this test done as well mostly because it is sometimes useful to be forewarned that this might be come a problem.

If you search for ‘celiac disease’ in PubMed you will find plenty of reports albeit rather technical ones; but if you could get to any medical library, even a small one, and looked up the term in a recent pediatric textbook you would probably find all you need. Another reference is http://www.uchsc.edu/misc/diabetes/eisenbook.html; the first page is an index and in the second half of the index you can find access to the full text of a book on the immunology of Type 1 Diabetes by Eisenbarth and Lafferty which includes a chapter on the autoimmune polyglandular or polyendocrine syndromes.

DOB