February 19, 2006
Celiac
Question from Singapore:
My 11 year old daughter has had type 1 diabetes since June 2004. She is doing fine with A1cs ranging from 6.9 to 7.1. She is on 18 units of Lantus and NovoRapid, five units for breakfast, four and a half units for lunch and three and a half units for dinner. She takes her Lantus in the afternoon. We are posted at Singapore and visit India every year. In November 2004, her endocrinologist in India, got her TTG tissue transglutaminase test done and it was 3.5. A year later, it was done again and the result was 200. The doctor in India told me to get this test done again as there is possibility of laboratory error. The doctor in Singapore told us to get serum anti-gliadin and anti-endomysial antibodies test done and both the test were negative. Her doctor in Singapore is telling us may be she is gluten sensitive and we should shift her to a gluten free diet. The Indian doctor is telling us to get the test done again and meet the specialist if the test is positive again. Shifting her to gluten free diet means more restrictions. Her overall development is okay. I am totally confused. What do you think?
Answer:
When one gets conflicting laboratory results, it is wise to recheck them at least once, if not several more times. Transglutaminase antibody is the best test for celiac disease and the most specific and sensitive. Endomysial and gliadin tests are less specific. With such discrepancies between two test results, laboratory problems are more likely the explanation, so, I would go to a high quality laboratory and redo the tests. Consultation with a pediatric gastroenterologist would also be reasonable if there still are some questions. Celiac disease co-exists in about 8% of youngsters with type 1 diabetes, is often asymptomatic and also co-exists with thyroiditis, all for similar reasons of sharing genetic HLA risks. Without any symptoms, it may be reasonable to recheck several more times before doing anything as restrictive as a gluten free dietary approach.
SB
