Celiac disease in an adult population with insulin-dependent diabetes mellitus: Use of endomysial antibody testing

Objective: Studies from Europe and North Africa suggest an association between type 1 diabetes mellitus (IDDM) and celiac disease (CD). Although IDDM is as common in the United States as it is in Europe, CD is diagnosed much less often in this country than in Europe. The purpose of our study was to determine the frequency with which CD occurs in patients with IDDM in the United States. Methods: Several serological tests are used for CD screening. The most specific and sensitive of these, the antiendomysial antibody, is the indirect immunofluorescence test which uses monkey esophagus smooth muscle as substrate. This test, which correlates closely with actual enteropathy, was used to screen 185 unselected patients with IDDM who attended the Diabetic Clinic or were housed on the Diabetic Unit of the University of Iowa Hospitals and Clinics. Results: Nine of 185 patients had positive IgA antiendomysial antibody tests. Antibody positivity did not correlate with the presence of diabetic complications, age, sex, or duration of IDDM. Five of nine antibody-positive patients underwent subsequent small intestinal biopsy. Enteropathy was confirmed in four of these patients. Conclusions: These data suggest that CD is more common in American patients with IDDM than was previously suspected.