Celiac disease autoimmunity among Nigerian children and adolescents with type 1 diabetes mellitus

Background: Celiac disease (CD) affects the small intestine and can hinder nutrient absorption. It is found worldwide and common in certain groups of people including individuals with Type 1 Diabetes Mellitus (T1DM). However, the prevalence of CD in the West African region is not documented. This study aimed to investigate the prevalence and pattern of CD autoimmunity in Nigerian children and adolescents diagnosed with T1DM.

Methods: This was a cross-sectional descriptive study of children and adolescents with T1DM at the Paediatric Endocrinology Clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and anthropometrics. The subjects were screened for markers of CD autoimmunity using anti-tissue transglutaminase antibody (tTG) and anti-endomysial antibody (EMA). Endoscopy and duodenal biopsy were recommended for participants with elevated CD-specific antibodies.

Results: The study recruited a total of 104 children and adolescents with TIDM, out of which six participants (5.8%) had CD autoimmunity. All six participants were females, aged between 3 and 12 years, with a mean age of 9.2 ± 3.7 years. Participants with CD autoimmunity were more likely to have DM diagnosed before the age of 10 years compared to those without CD autoimmunity (83.3% vs. 37.7%, p = 0.149). Except for two participants, all individuals with CD autoimmunity experienced gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and bloating.

Conclusion: This study highlights the occurrence of CD autoimmunity in Nigerian children and adolescents with TIDM. Healthcare providers should consider screening for celiac disease in children and adolescents with T1DM, particularly in females and when gastrointestinal symptoms are present. Additionally, the findings from this study suggest that there is a high probability of a significant burden of CD, even within the general population in Nigeria. Therefore, it's important to maintain a high level of suspicion and to actively screen at-risk groups in clinical settings to ensure early diagnosis of CD.