0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Gluten-Sensitive Enteropathy in Patients with Insulin-Dependent Diabetes Mellitus

Michael J. Rensch, MD; John A. Merenich, MD; Michael Lieberman, PhD; Brian D. Long, BS, CRC; Dirk R. Davis, MD; and Peter R. McNally, DO
[+] Article and Author Information

From Fitzsimons Army Medical Center, Aurora, Colorado, and the University of Colorado Health Sciences Center, Denver, Colorado. Disclaimer: The opinions and assertions contained herein are those of the authors and are not to be construed as official policy or as the views of the Department of Defense. Requests for Reprints: Peter R. McNally, DO, Gastroenterology Service, Department of Medicine, Fitzsimons Army Medical Center, Aurora, CO 80045-5000. Current Author Addresses: Dr. Rensch: 20 Alondra Court, Colorado Springs, CO 80919.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;124(6):564-567. doi:10.7326/0003-4819-124-6-199603150-00004
Text Size: A A A

Objective: To determine the prevalence of celiac disease in a cohort of patients with insulin-dependent diabetes mellitus and to describe the clinical characteristics of patients with coexistent disease.

Design: Prospective cohort study.

Setting: U.S. Army medical center.

Patients: 47 patients with insulin-dependent diabetes mellitus.

Measurements: Antiendomysial antibody testing was used to screen for celiac disease. The diagnosis of celiac disease required histologic evidence of villous atrophy and crypt hyperplasia and a positive antiendomysial antibody test result. In patients identified as having coexistent disease, complete blood counts, multiphasic biochemical testing, D-xylose absorption testing, and bone mineral density estimates were done.

Results: 3 of 47 patients with insulin-dependent diabetes mellitus (6.4%; 95% CI, 1.4% to 17.5%) had positive antiendomysial antibody test results and small-bowel biopsy specimens consistent with celiac disease. The 95% CI lies entirely above the estimated prevalence of celiac disease expected in the general U.S. population, which ranges from 0.02% to 0.1%. Mean bone mineral densities were 0.8 and 1.1 SD below age-, ethnicity-, and sex-matched controls in each of the 2 antiendomysial antibody-positive patients tested. Small-bowel absorption was abnormal in 1 of the 2 patients tested by D-xylose. Anemia and hypoalbuminemia were not detected in any of the patients with coexistent disease. Only 1 of the 3 patients had symptoms of diarrhea. All patients were at or above their ideal body weights.

Conclusions: Celiac disease appears to be more common among patients with insulin-dependent diabetes mellitus than in the general U.S. population (P < 0.001). Two of the three patients with coexistent disease in this study had subclinical or latent celiac disease.

Figures

Grahic Jump Location
Figure 1.
Photomicrograph of small-bowel biopsy specimen from patient T9369.

Shows characteristic histologic findings of celiac disease: marked villous atrophy, crypt hyperplasia, and expansion of the lamina propria with lymphocytes.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)