Clinical and Immunological Features of Celiac Disease in Patients With Type 1 Diabetes Mellitus

Umberto Volta; Francesco Tovoli; Giacomo Caio


Expert Rev Gastroenterol Hepatol. 2011;5(4):479-487. 

In This Article

Duodenal Histology of CD in T1DM

As stated earlier, small intestinal biopsy is still the gold standard for CD diagnosis. The finding of a histological picture of villous atrophy, associated with an increased number of intraepithelial lymphocytes (IEL), indicates a definite CD diagnosis, irrespective of serology results.[50] Three different grades of villous atrophy characterize CD histological picture, namely type 3a (mild), 3b (partial) and 3c (subtotal) according to Marsh–Oberhuber classification.[51] However, the pitfalls linked to the interpretation of duodenal histology are particularly relevant in the T1DM subgroup. First of all, a high number of T1DM patients show an infiltrative lesion at the intestinal level with an increased number of IEL (>25%, type 1 lesion) with normal villi.[35] This lesion, which is characteristic of T1DM, as well as of many other autoimmune conditions such as autoimmune thyroiditis, rheumatoid arthritis and systemic lupus erythematosus, is consistent with, but not specific to, CD.[52] Only 10% of patients with type 1 lesion showing positivity for tTGA and/or EmA are affected by CD. This form of CD is defined as potential CD and it should be regarded as an initial form of gluten-sensitive enteropathy – the treatment of which by GFD is still controversial. Treatment by GFD is recommended only in cases with symptomatic potential CD.[53]


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