1. Associated Conditions

2. Associated Conditions
The prevalence of Celiac Disease is higher in patients who have the following:
Certain genetic disorders or syndromes
Other autoimmune conditions
Relative of a biopsy-proven celiac

3. Associated Conditions20 16 12
percentage 8 4
General
Population
Relatives
IDDM
Thyroiditis
Down
syndrome

4. Genetic Disorders Down Syndrome: 4-19% Turner Syndrome: 4-8%
Williams Syndrome: 8.2%
IgA Deficiency: 7%
Can complicate serologic screening

5. Prevalence of Celiac Disease is Higher in Other Autoimmune Conditions
Type 1 Diabetes Mellitus: %
Thyroiditis: 4 - 8%
Arthritis: %
Autoimmune liver diseases: 6 - 8%
Sjögren’s syndrome: %
Idiopathic dilated cardiomyopathy: 5.7%
IgA nephropathy: 3.6%

6. Relatives Healthy population: 1:133 1st degree relatives: 1:18 to 1:22
2nd degree relatives: 1:24 to 1:39
Fasano, et al, Arch of Intern Med, Volume 163: , 2003

7. Type 1 Diabetes Patients are often asymptomatic
Nocturnal hypoglycemia with seizures
TTG may be falsely positive
Gluten–free diet challenging
2 U.S. studies in pediatrics:
218 patients. 7.7% EMA+. 4.6% biopsy + (Aktay et al. JPGN 2001;33: )
185 patients. 5% EMA+. 4/5 biopsy + (Talal et al. AJG 1997;92: )

8. Which Came First?

9. Celiac Disease and Autoimmunity
Prevalence of autoimmune disorders in celiac disease related to duration of gluten exposure
Diagnosed before 2 years of age: 5%
Age 2-10 years: 17%
Greater than age 10 years: 24%
Increased incidence of autoimmune disease in patients with IDDM and ‘silent’ Celiac Disease and their first degree relatives who were EMA+
Ventura et al, Gastro 1999; Not , Diabetologia 2001