Proyecto de doctorado (Ph.D. project) en Karolinska Institutet

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1 INVESTIGACION CIENTIFICA Proyecto de doctorado (Ph.D. project) en Karolinska Institutet Celiac Disease in Children and Adolescents with Type 1 Diabetes Mellitus - Prevalence, Presentation and Perception Articulo publicado High prevalence of Celiac Disease in Swedish children and adolescents with Type 1 Diabetes and the relation to the Swedish Epidemic of Celiac Disease: a cohort study, Bybrant et al. Scandinavian Journal of Gastroenterology 2013 Scandinavian J ournal of Gastroenterology. 2014; 49: ORIGINAL ARTICL E DIABETES H igh prevalence of celiac disease in Swedish children and adolescents with type 1 diabetes and the relation to the Swedish epidemic of celiac disease: a cohort study Scand J Gastroenterol Downloaded from informahealthcare.com by on 10/07/14 For personal use only. MARA CERQUEIRO BYBRANT 1, 2, EVA ÖRT QVIST 2, 3, SOPHIE LANT Z 2, 4 & LENA GRAHNQUIST 1, 2 1 Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children s Hospital, Karolinska University Hospital, Stockholm, Sweden, 2 Department of Women s and Children s Health, Karolinska Institutet, SE , Stockholm, Sweden, 3 Pediatric Diabetes Clinic, Astrid Lindgren Children s Hospital, Karolinska University Hospital, Stockholm, Sweden, and 4 Department of Orthopedics, Västervik CountyHospital, SE-59381, Västervik, Sweden (at the time of thestudy medical student, Karolinska Institutet) Abstract Aim. Theaimwastodeterminetheprevalenceand clinical and temporal relationship of celiac disease(cd) in apopulation of Swedish children with type1 diabetes mellitus (T1DM ) before, during, and after theswedish epidemic of CD (birth cohorts ). Methods. Retrospective chart review between 1995 and 2005 wasconducted of 1151 children (0 18years old, born ) with T1DM. Results. A prevalence of 9.1% (95% CI: ) of CD in T1DM children was found. No significant difference in prevalence of CD was observed in different birth years, in contrast to theswedish epidemic of CD. Sixty-two percent of children diagnosed with CD after T1DM onset had pathological levels of antibodies within the first 24 months. Thepresenceor absenceof gastrointestinal symptoms had no predictablevaluefor biopsy-confirmed CD or not. Conclusion. The onset of CD in the T1DM population does not follow the pattern of the general population during the Swedish epidemic of CD. Theshared genetic component in thehuman leukocyteantigen region in caseswith comorbidity of CD andt1dm mayoverruleother CD-causingfactorsinthegeneral population. ChildrenwithT1DM should bescreened for CD at diagnosis and repeatedly at least during the first 2 years, even if asymptomatic. Key Words: Celiac disease, children, prevalence, screening, type1 diabetes mellitus Articulo Introduction en progreso Co-occurrence of celiac disease (CD) and type 1 diabetes mellitus (T1DM ) in children is a challenge for patients, parents, and healthcare professionals. Both CD and T1DM are autoimmune disorders with a shared genetic background, both in human leukocyte antigen (HLA) genes and non-hla genes [1 4]. Children with T1DM can be screened with auto-antibodiesfor CD [3,5,6], and thecd diagnosis should be confirmed with small bowel biopsy [7,8]. The prevalence of CD in the general population worldwide is about 1% [1,9] and between % in Swedish children [10,11]. The prevalence has increased over time, and CD is more common in females than males [12,13]. The risk of CD in childhoodfollowsregionalvariations[14].inthemid-1980s, pediatricians throughout Sweden diagnosed an increasing number of children with CD (most were under 2yearsofage). ThecumulativeincidenceofCD reached levelshigher than reported previously, from1 to4casesper 1000births. Theincidencecontinued to behigh duringten yearsand then decreased rapidlyto theincidenceat baseline. Thehigh incidenceratethat wasshowninswedishchildren bornbetween1984and 1996 isknown astheswedish epidemic of CD. It has Transglutaminase antibodies in Swedish children with newly diagnosed Type 1 Diabetes in relation to HLA genotypes and islet autoantibodies: a nationwide prospective population-based cohort study (manuscript) Presentaciones en congresos Noviembre 2014 Presentación oral en el IV Congreso Nacional de la Sociedad Correspondence: MaraCerqueiro Bybrant, MD, Pediatric Gastroenterology, Hepatology and Nutrition, Astrid Lindgren Children s Hospital, Karolinska Española University Hospital, de SE Stockholm, Sweden. T el: Fax: Enfermedad mara.bybrant@ki.se Celíaca, Valencia (Received 3 July 2013; revised 10 August 2013; accepted 15 September 2013) TISSUE TRANSGLUTAMINASE AUTOANTIBODIES IN NEWLY ISSN print/issn online Ó 2014 Informa Healthcare DOI: / DIAGNOSED CHILDREN WITH TYPE 1 DIABETES MELLITUS IN RELATION TO HLA-GENOTYPES AND ISLET AUTOANTIBODIES

2 Octubre 2013 Pediatric type 1 diabetes autoantibodies Presentación de poster en el congreso International Sociaty DIabetes, Göteborg Transglutaminase antibodies in Swedish children with in relation to HLA types and islet Septiembre 2013 Granada Presentación de poster en International Nutritiment Congress, Increasing obesity in Europe. What can we

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4 Marzo 2013 el Diabetes Presentación sobre enfermedad celiaca en niños con diabetes en Forum, Estocolmo Septiembre 2012 Presentación oral en ESPGHAN Summer School, Madrid

5 Celiac Disease Compliance to the gluten free diet in adolescents with Junio 2011 Presentación de poster International Celiac Disease Symposium, Oslo High prevalence of Celiac Disease in Swedish children and adolescents with Diabetes Mellitus type 1

6 High prevalence of Celiac Disease in Swedish children and adolescents with Diabetes Mellitus type 1 Mara Cerqueiro Bybrant, Eva Örtqvist, Lena Grahnquist Astrid Lindgren Children s Hospital, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden Karolinska Institutet & Karolinska University Hospital Mara Cerqueiro Bybrant M.D. Astrid Lindgren Children s Hospital Department of Woman and Child Health SE Stockholm Sweden E-post: mara.bybrant@karolinska.se Direct: Abbreviations CD celiac disease T1DM diabetes mellitus type 1 AGA anti-gliadin antibodies EMA anti-endomysium antibodies ttga anti-tissue transglutaminase CI confidence interval References 1. Larsson, K., et al., Annual screening detects celiac disease in children with type 1 diabetes. Pediatr Diabetes, (4 Pt 2): p Myléus, A., et al., Celiac disease reveal in 3 % of Swedish 12-years-old born during an epidemic. J Pediatr Gastroenterol Nutr Aug;49(2): Junio 2006 Helsinggör Presentación de poster en el Congreso Nacional de Pediatria, Celiaki hos barn med diabetes typ-1

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