Evidence map›Paper›PMID 42696249›Full record

ArticleDigestive diseases and sciences2026

Predictors of Progression to Villous Atrophy in Children with Type 1 Diabetes and Potential Celiac Disease.

Madan Neelamegam, Raghav Lal, Sadhna B Lal, Alka Bhatia, Devi Dayal, Bijaya Kumar Padhi, Yashwant Kumar, Kaushal Kishore Prasad, Suvradeep Mitra, Chennakeshava Thunga

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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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5 · Who and what money

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10 authors.

Madan Neelamegam *Department of Pediatric Gastroenterology & Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Raghav Lal *Department of Immunopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Sadhna B LalDepartment of Pediatric Gastroenterology & Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India. sadhnalal2014@gmail.com.ORCID https://orcid.org/0000-0003-0908-3650
Alka BhatiaDepartment of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Devi DayalDepartment of Pediatric Endocrinology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Bijaya Kumar PadhiDepartment of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Yashwant KumarDepartment of Immunopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Kaushal Kishore PrasadDivision of Gastrointestinal Pathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Suvradeep MitraDepartment of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
Chennakeshava ThungaDepartment of Pediatric Gastroenterology & Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.

Funding

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6 · The paper itself

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.

Indexed as

Potential celiacPredictorsType 1 diabetesVillous atrophyγδ T cells/CD3 T cell ratio

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