ArticleDigestive diseases and sciences2026
Predictors of Progression to Villous Atrophy in Children with Type 1 Diabetes and Potential Celiac Disease.
Article in Digestive diseases and sciences, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChildren with type 1 diabetes (T1DM) and positive celiac serology but normal duodenal mucosa (potential celiac disease-CeD) often have spontaneous normalization of serology despite a gluten-containing diet. This results in either repeated biopsies or an upfront advice for gluten-free diet (GFD) if TTG is >10ULN.
objectivesTo find the predictors of villous atrophy in children with T1DM and potential CeD.
designAmbispective observational study: Children with T1DM and potential CeD on a gluten-containing diet were included. Clinical, serological, histological, and immunohistochemical parameters at baseline and follow-up biopsy were evaluated.
resultsOf the 110 children with T1DM and positive celiac serology, 66 (60%) were potential CeD. Forty-three children had follow-up and repeat biopsy after a median of 12 months; 10 (23%) developed villous atrophy (VA), 16 (37%) remained potential CeD, and 17 (40%) had spontaneous normalization of serology. Children who developed VA had higher baseline counts of intraepithelial lymphocytes (IELs), γδ T cells, and CD3 T cells. In multivariate analysis, the baseline γδ T cell/CD3 T cell ratio was an independent predictor of progression to VA (OR 1.15; 95%CI 1.03-1.28; p=0.011; AUROC 0.918). Spontaneous normalization/reduction of TTG-IgA to < 5ULN was associated with reduced risk of VA (OR 0.007, 95%CI 0.00007-0.617; p = 0.030); Combined AUROC for both was 0.972. VA developed in only 26% (6/23) with TTG ≥10 ULN at baseline.
conclusionsMost children with T1DM and positive celiac serology do not progress to VA; initiating a GFD without biopsy solely on the basis of TTG>10ULN may be unjustified. Baseline elevation in γδ T-cells/CD3 T cell ratio and persistently high serological titres help identify the risk of progression to VA.
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