The prevalence of celiac disease (CD) in children with type 1 diabetes (T1D) is 5.1%, and it is often asymptomatic (1). Thus, children with T1D are routinely screened for CD with assessment of IgA antibodies against tissue transglutaminase (TGA-IgA). However, elevated TGA-IgA at T1D onset can normalize spontaneously without a gluten-free diet (2,3). The cause of this remains unknown, but genetic variations may influence CD outcomes (2). The European Society of Paediatric Gastroenterology Hepatology and Nutrition recommends a nonbiopsy approach for diagnosis of CD in children with TGA-IgA values >10 times the upper limit of normal (>10×ULN) who have a positive result on an endomysial IgA test in a second blood sample (4). An endomysial IgA test is expensive, with limited availability in some regions of the world, which raised the question of CD diagnosis based on TGA-IgA alone. Therefore, we performed a retrospective analysis to explore the diagnostic outcome of children with newly diagnosed T1D with elevated TGA-IgA in an Australian center where duodenal biopsy is pursued for diagnosing CD.
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