Estudo da prevalência da doença celíaca em crianças e adolescentes com diabetes melito tipo 1: resultado de 10 anos de acompanhamento

Abstract

OBJETIVO: Avaliar a prevalência da doença celíaca (DC) em crianças e adolescentes com diabetes melito tipo 1 (DM1) atendidos no Serviço de Endocrinologia Pediátrica do Hospital das Clínicas da Universidade Federal de Minas Gerais. SUJEITOS E MÉTODOS: Incluídos no estudo crianças e adolescentes com diagnóstico prévio de DM1 acompanhadas no serviço no período de março de 1999 a abril de 2009, com idades entre zero e 18 anos. Todos foram rastreados para DC na primeira consulta e anualmente. A investigação foi realizada por meio da dosagem dos anticorpos da classe IgA (AGAA) e IgG (AGAG) antigliadina. Os pacientes com AGAA e/ou AGAG acima de duas vezes o valor de referência foram submetidos à biópsia intestinal. RESULTADOS: Foram excluídos 21 pacientes do total inicial de 384. Destes, 50 tiveram a sorologia positiva e 29 foram submetidos à biópsia intestinal. A prevalência encontrada foi de 3,1%. CONCLUSÃO: O rastreamento periódico da DC nos pacientes diabéticos deve ser encorajado, dada sua alta prevalência.

Association of type 1 diabetes mellitus and autoimmune disorders in Brazilian children and adolescents

“…[ 4 30 ] The screening for CD is performed by the research of anti-endomysial, anti-gliadin, or anti-tTG IgA human (Ac anti-tTG) antibodies. [ 5 26 ] The anti-tTG antibody has good sensitivity and specificity, occurring in more than 95% of patients with biopsy-proven CD. [ 28 ] The survey of the anti-endomysial antibody has the same accuracy of anti-tTG but is more expensive and observer-dependent, while the research of anti-gliadin antibodies, because they are less sensitive and specific, is not recommended for the screening of CD.…”

“…[ 28 ] The survey of the anti-endomysial antibody has the same accuracy of anti-tTG but is more expensive and observer-dependent, while the research of anti-gliadin antibodies, because they are less sensitive and specific, is not recommended for the screening of CD. [ 5 ] It is advisable to determine the level of serum IgA. [ 31 ] In individuals with deficiency of IgA, survey of anti-tTG IgG, anti-endomysial IgG, or anti-gliadin IGg antibodies can be done.…”

“…There is no exact definition of how and when to screen for autoimmune diseases in these patients and on the ethical aspects involved in the monitoring and treatment, in the case of positive laboratory results. [ 5 ] However, the study of demographic, immunologic, and genetic characteristics may contribute to prevent complications and provide future guidelines in the care to these patients. [ 4 ]…”

Triagem sorológica para doença celíaca em adolescentes

“…Several studies have showed and recommended the anti-tTG-IgA antibody as the best serological test available for CD screening, being useful to identify new CD patients with light symptoms, non-specific general complaints or extra-intestinal manifestations, as well as population and epidemiological tracking 2,3,7, 12,23,29 . The determination of the anti-tTG-IgA antibody through ELISA is a reliable test with 90 to 99% sensitivity and a specificity of 94 to 100% 2, 16,30,31 . It is worth mentioning that studies have showed that most subjects with positive anti-tTG antibody have CD confirmation through biopsy 2, 16,31 , and such test has a good correlation with the severity and extension of intestinal lesions found in the biopsy 2 .…”

“…The limitation of the present study was that the levels of IgA were not measured. Deficiency of IgA might be associated with CD, and under such conditions, the serologic test tends to yield false-negative results 8, 15,23,30 .…”