Frequency and predictive factors for spontaneous normalization of anti-tissue transglutaminase-IgA serology among Saudi children with type 1 diabetes mellitus: A cohort study

• Published in: Saudi journal of gastroenterology 2023-09, Vol.29 (5), p.278-285
• Main Authors: Al Sarkhy, Ahmed, Al Hassan, Ali, Assiri, Heba, Alabdulkarim, Hayfa, AlAnazi, Noor, Alshammari, Nawaf, AlOtaibi, Najla, Al Asmi, Mona, Assiri, Asaad, Al-Khalifah, Reem, Ahamed, Shaik Shaffi, El Mouzan, Mohammad
• Format: Article
• Language: English
• Subjects: Analysis; anti-ttg-iga antibodies; Antibodies; celiac disease; children; Cohort analysis; Diabetes; Gluten; Immunoglobulin A; Original; resolution; Serology; type 1 diabetes mellitus
• ISSN: 1319-3767; 1998-4049
• DOI: 10.4103/sjg.sjg_25_23

Celiac serology can be transiently elevated in patients with type 1 diabetes mellitus (T1DM) and normalized despite gluten consumption. This study aimed to identify the frequency and predictive factors of spontaneous normalization of anti-tissue transglutaminase (anti-TTG-IgA) antibodies in these patients. The charts of all patients (≤18 years) with T1DM were retrospectively reviewed from 2012 to 2021 at a tertiary care center in Riyadh, Saudi Arabia. The following data were collected: clinical characteristics of the participants, anti-TTG-IgA-immunoglobulin (Ig) A antibody, and histological findings. The outcome of positive anti-TTG-IgA-IgA in patients with T1DM and the predictive factors for spontaneous normalization were investigated. Of the 1,006 patients with T1DM, 138 (13.7%) had elevated anti-TTG-IgA antibodies, celiac disease was diagnosed in 58/138 (42%) patients, spontaneous normalization of anti-TTG-IgA was observed in 65 (47.1%) patients, and fluctuating anti-TTG-IgA antibodies were seen in 15 (10.9%) patients. The patients with anti-TTG-IgA levels at 3-10 times the upper normal limits (UNL), and those with levels ≥10 times UNL were less likely to have spontaneous normalization of anti-TTG-IgA compared to patients with levels at 1-3 times UNL (hazard ratio [HR] = 0.28, 95% confidence interval [Cl] = 0.13-0.61, P = 0.001, and HR = 0.03, 95% Cl = 0.00-0.19, P < 0.001, respectively). Asymptomatic patients with T1DM with mild elevation of anti-TTG-IgA need not be rushed for invasive endoscopy or exposed to an un-needed gluten-free diet but should rather have a regular follow-up of their celiac serology.