Estudo da prevalência sorológica de doença celíaca em pacientes com Diabetes do tipo 1

Abstract

Celiac Disease (CD) is a chronic illness that develops lesions on the small intestine, caused by wheat ingestion. CD may present such forms: classical (symptomatic or active), atypical and assymptomatic (silent). Actually, it is more frequently assymptomatic, with a ratio of cases symptomatics to assymptomatics cases of 1:5 - 1:7. The classical symptoms are nausea, irritability, anorexia, growth failure, abdominal pain and diarrhea. Extra-abdominal manifestations, such as osteoporosis, infertility and malignance intestinal illnesses may occur. Other complications, such as diabetes mellitus type I (I-DM), have been associated to celiac disease. On recent decades, the introduction of sensitive and specific serologic markers to CD (such as anti-gliadin, anti-endomisium and anti-tissue transglutaminase antibodies), allows a reavaliation of the prevalence and of the clinical spectrum associated to the disease. The diagnosis is based on a single biopsy of the small intestine and the presence of at least one of the CD specific antibodies. In contrast with European data, the CD is not frequently diagnosed in Brazil. It is estimated that the disease affects 1 in 85 to 300 individuals of European descendents populations, whereas, in Brazil, the first recent study demonstrated a prevalence of 1:681. There are evidences that CD is subdiagnosed and that serologic tests have the potential to detect subclinical forms of the undiagnosed disease. These estimates of prevalence are applied to the general population, however, in predisposed individuals, the risk of the disease is higher. On individuals with I-DM, the reported prevalence of CD varies from 0.6 to 16.4%. Some data suggest that the prevalence of autoimmune diseases is closely related to the period of exposure to gluten, suggesting that the precoce elimination of gluten may prevent the manifestation of other complications. Due to the known high prevalence of DC on the diabetic population and the suspected high frequency of the latent and silent forms of the disease in children, the screenning of those have been suggested. The present study was drawn to investigate the serologic prevalence of CD in individuals with I-DM on Niterói and suburbs. Forty nine patients with I-DM were included in the study after the inclusion criteria (32 F:17 M, 47±05 years). The blood samples of the included patients were submited to serologic tests to verify the presence of antibodies anti-AGA, -EmA e -tTG. Were considered positive, to CD, the patients with positive serologic reaction to EmA (IgA and/or IgG) and to tTG (IgA). Of these patients, four (3F:1M, 18±07 years) presented serologic results indicative of CD, corresponding to 8,16% of the total population studied. The celiac patients with I-DM detected had few or none clinical characteristics of the disease. The presence of CD was not related to gastrointestinal symptoms suggestive of CD, neither with the period of existence of IDM. The sensivity and specificity of IgA anti-EmA and IgA anti-tTG were similar, but the sensivity to IgG-EmA was not so high. Concluding, the high prevalence and the frequent silent cases of CD in patients with I-DM suggest that brazilian children with diabetes mellitus type I should be screened for precoce diagnosis and treatment of CD, preventing future severe complications.