From the Guidelines
Screening for celiac disease is recommended for individuals with type 1 diabetes mellitus, autoimmune thyroid disease, Down syndrome, Turner syndrome, Williams syndrome, selective IgA deficiency, and first-degree relatives of patients with celiac disease. These comorbidities have been identified as high-risk groups for developing celiac disease, an autoimmune condition that can lead to complications such as malnutrition, osteoporosis, infertility, and small intestinal lymphoma if left untreated 1.
Key Comorbidities Requiring Screening
- Type 1 diabetes mellitus
- Autoimmune thyroid disease (both Hashimoto's thyroiditis and Graves' disease)
- Down syndrome
- Turner syndrome
- Williams syndrome
- Selective IgA deficiency
- First-degree relatives of patients with celiac disease
Screening Recommendations
Screening typically involves serologic testing with tissue transglutaminase IgA antibody (tTG-IgA) and total serum IgA to rule out IgA deficiency, as recommended by the American Diabetes Association 1. If IgA deficiency is present, IgG-based testing (deamidated gliadin peptide antibodies or tTG-IgG) should be used instead. Positive serologic tests should be followed by intestinal biopsy for confirmation before starting a gluten-free diet. The British Society of Gastroenterology also recommends testing for celiac disease in individuals with suggested symptoms or syndromes, especially if they have a first-degree relative with celiac disease 1.
Importance of Early Detection and Dietary Management
Early detection and dietary management in these high-risk groups can prevent complications associated with celiac disease. A gluten-free diet can reduce symptoms and hypoglycemia in patients with diabetes and celiac disease, as noted in a position statement by the American Diabetes Association 1. Regular screening and monitoring are essential to ensure timely diagnosis and treatment of celiac disease in individuals with these comorbidities.
From the Research
Comorbidities Requiring Screening for Celiac Disease
Comorbidities that require screening for celiac disease include:
- Type 1 diabetes mellitus 2, 3, 4, 5
- Autoimmune thyroid disease 2, 3, 4
- Down's syndrome 2, 3
- Turner syndrome 2, 3
- Iron deficiency anemia 2
- Unexplained chronic diarrhea 2
High-Risk Groups for Celiac Disease
High-risk groups for celiac disease that should be screened include:
- First-degree relatives of CD patients 2
- Patients with genetic syndromes such as Turner and Down syndromes 2, 3
- Patients with other autoimmune diseases, such as type 1 diabetes and autoimmune thyroid disease 4
Importance of Screening
Screening for celiac disease is important in these high-risk groups because celiac disease can be asymptomatic, and early diagnosis and treatment can prevent long-term complications 2, 3, 4. Additionally, patients with celiac disease are at increased risk for other autoimmune diseases, such as type 1 diabetes and autoimmune thyroid disease, and screening for these conditions is also important 4.