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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 3  |  Page : 761-764

Celiac, thyroid diseases, and Helicobacter pylori infection in association with type 1 diabetes mellitus


1 Department of Pediatrics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Damanhour Teaching Hospital, Damanhour, Egypt

Date of Submission20-Jul-2016
Date of Acceptance02-Oct-2016
Date of Web Publication15-Nov-2017

Correspondence Address:
Heba S Elsaka
Shubrakhit, Damanhour, 22514
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.218275

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  Abstract 

Objectives
To study the association between the diagnostic markers of celiac, thyroid diseases, and Helicobacter pylori infection with type 1 diabetes mellitus (T1DM) and the effect of these diseases on glycemic control.
Background
T1DM is a chronic metabolic disease characterized by chronic hyperglycemia because of defects in insulin secretion or action or both, and results from the autoimmune destruction of the insulin-producing β-cells in the pancreas. It is commonly associated with autoimmune diseases such as celiac and thyroid diseases. There is a higher prevalence of H. pylori infections in T1DM.
Patients and methods
This study included 60 patients who presented with T1DM ranging in age from 1 to 16 years, of both sexes, with different disease durations. Children with secondary diabetes, congenital anomalies in any part of the body, or other autoimmune diseases (systemic lupus erythematosus, nephrotic syndrome, rheumatoid arthritis) were excluded. The patients were compared with 32 normal children of the same age, sex, and socioeconomic status. Comparisons were made by structured reviews and the results were tabulated.
Results
The frequency of celiac disease at the diagnosis of T1DM is 0, the frequency of thyroid disease at diagnosis of T1DM is 5%, and the frequency of H. pylori infection in diabetic patients is 56.7%; however, in the control group, the frequencies were 15.6%. There is a significant relation between the frequency of H. pylori infection and increased duration of T1DM.
Conclusion
Screening for celiac disease, thyroid disease, and H. pylori infections at diagnosis of T1DM is important, and rescreening at regular intervals is important for the negative cases.

Keywords: celiac, Helicobacter pylori, thyroid, type 1diabetes


How to cite this article:
Elgendy FM, El-Latif Omar ZA, Zearaban NH, Elsaka HS. Celiac, thyroid diseases, and Helicobacter pylori infection in association with type 1 diabetes mellitus. Menoufia Med J 2017;30:761-4

How to cite this URL:
Elgendy FM, El-Latif Omar ZA, Zearaban NH, Elsaka HS. Celiac, thyroid diseases, and Helicobacter pylori infection in association with type 1 diabetes mellitus. Menoufia Med J [serial online] 2017 [cited 2020 Mar 30];30:761-4. Available from: http://www.mmj.eg.net/text.asp?2017/30/3/761/218275


  Introduction Top


Type 1 diabetes mellitus (T1DM) is an autoimmune disease in which T-cell-mediated destruction of pancreatic β-cells occurs. Genetic susceptibility and environmental triggering factors yet to be identified seem to be responsible for T1DM [1].

A preclinical phase, termed 'prediabetic,' precedes the onset of overt disease; during this prediabetic period, there is an active autoimmune process against several pancreatic peptides, including insulin and glutamic acid decarboxylase. During the past few years, several assays to detect autoantibodies against these molecules have been developed, and the presence of humeral markers, in combination with metabolic and genetic data, enables a more precise definition of the risk of T1DM [2].

Gluten-sensitive enteropathy or celiac disease is a heterogonous disorder involving abnormalities in the small intestinal mucosa, which ranges from silent asymptomatic forms to active mal absorption syndromes. Although the pathogenesis of the disease remains unclear, it involves both genetic determinants and environmental factors. Gluten has been identified as the trigger molecule in the development of celiac disease. The presence of different antibodies (antigliadin, tissue transglutaminase antibodies) is indicative of possible celiac disease, but diagnostic confirmation is made on the basis of histologic examination of specimens obtained.

The association between thyroid disease and T1DM is related to the autoimmune phenomenon autoimmune thyroiditis, which is often clinically silent but may progress to either overt or subclinical hypothyroidism or hyperthyroidism abnormalities in the thyroid function test; this occurs in 20–30% of patients with T1DM [3].

Hypothyroidism will lead to growth delay, weight gain, menstrual abnormalities, hyperlipidemia, and cardiovascular complications in patients with T1DM, whereas hyperthyroidism leads to worse metabolic control in diabetic patients. Therefore, there is an increased need to increase the insulin dose and this could lead to diabetic ketoacidosis [4].

Helicobacter pylori infection affects ~50% of the world's population and is recognized as the major acquired factor in the pathogenesis of chronic enteral gastritis, peptic ulcer disease, and gastric cancer. Identification of risk groups is very important in this respect. Impairment of the immune system is considered to be responsible for more frequent and severe infections in diabetic patients [5].

In addition, bacterial overgrowth in the upper gastrointestinal tract because of delayed gastric emptying has been suggested; the relationship between H. pylori infection and late complications of T1DM is not clear [6].


  Patients and Methods Top


This study included 60 patients who presented with T1DM at the Endocrinology Unit in Damanhur Teaching Hospital, their ages ranging from 1 to 16 years, of both sexes, and 32 apparently normal children of the same age, sex, and socioeconomic status.

Inclusion criteria

The initial search yielded 60 patients, their ages ranging from 1 to 16 years, of both sexes, with different disease durations.

Exclusion criteria

Children with secondary diabetes, congenital anomalies in any part of the body, or other autoimmune diseases (systemic lupus erythematosus, nephrotic syndrome) were excluded.

All the groups studied were subjected to the following.

Detailed assessment of history

An assessment of personal history was performed including age and sex, age of onset of diabetes and its duration, consanguinity and birth order, family history of diabetes, history suggestive of gastritis or dyspeptic symptoms, whether the presentation is classical or with diabetic ketoacidosis, area of residence (rural or urban), and treatment administered.

A thorough clinical examination was performed with a focus on general examination, chest and heart examination, blood pressure measurements, and thyroid gland examination.

Anthropometric measurements: weight, height, BMI, and measurements for both the studied and the control group were determined according to growth charts [7].

Routine investigations

Random blood sugar in mg/dl, fasting, and postprandial glucose level in mg/dl were determined, kidney functions were assessed by determination of blood urea and serum creatinine using the enzymatic rate method [8], and estimation of hemoglobin A1c was performed by affinity chromatography [9].

Specific investigations

Serum level of free thyroxin was measured by enzyme-linked immunosorbent assay and serum level of thyroid-stimulating hormone (TSH) was measured by enzyme-linked immunosorbent assay [10]. Serum level of thyroid antibodies test (antithyroid peroxidase antibodies, anti-thyroglobulin antibodies) [3], serum tissue transglutaminase antibodies and antigliadin antibodies [11], H. pylori antigen in stool [12].


  Results Top


The frequency of celiac disease at the diagnosis of T1DM is 0, the frequency of thyroid disease at the diagnosis of T1DM is 5%, and the frequency of H. pylori infection in diabetic patients is 56.7%; however, in the control group, the frequency was 15.6%. There is a significant relation between the frequency of H. pylori infection and increased duration of T1DM, where P value is 0.031 [Table 1], [Table 2], [Table 3], [Table 4], [Table 5].
Table 1: Distribution of the patients in the diabetic group in terms of their clinical data

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Table 2: Clinical presentation with dyspeptic symptoms of the patient group studied

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Table 3: Distribution of the patient group studied in levels of hemoglobin A1c

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Table 4: Thyroid status for the group of diabetic patients

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Table 5: Comparison between the subgroup of patients in the result of Helicobacter pylori

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  Discussion Top


H. pylori is a bacterium that is prevalent worldwide, and infects the human gastric mucosa; generally, it persists for life in the infected tissue unless adequately treated [13]. Overall, 50% of the world's population carries H. pylori in their stomach, with an incidence up to 80% in developing countries [14]. This study investigates the prevalence of H. pylori in diabetic patients and the possible role of the infection in their metabolic control.

Few studies have investigated the prevalence of H. pylori in diabetic patients and a possible role of the infection in their metabolic control, with discordant results [15].

Our study shows that H. pylori positivity was detected in 56.7% of the patients with T1DM and in 15.6% of the children in the control group. However, Marrollo et al. [16] found that the prevalence of H. pylori infection was 74.4% in diabetes mellitus patients and 50% in the control group; it was significantly higher in the diabetes mellitus group compared with the control group (P = 0.0013). However, some studies did not find any significant difference in the diabetic group and the control group with respect to H. pylori infections [17].

In terms of the relationship between gastrointestinal symptoms (dyspeptic symptoms) in diabetes and H. pylori infection, our findings confirmed that the prevalence of gastrointestinal tract symptoms in H. pylori-positive and H. pylori-negative diabetics patients was statistically insignificant (P = 0.223).

This was in agreement with a study by Anastasios et al. [18] that reported that there is no difference between diabetics and nondiabetics in the prevalence of H. pylori-related gastroduodenal disorders.

Screening for autoimmune immune thyroid disease in T1DM enables the diagnosis of thyroid disease in an early stage and thus prevents complications [19].

Annual screening with TSH measurements should be performed as autoantibodies may persist for many years without thyroid dysfunction [4].

In our study, laboratory screening for thyroid dysfunction (free thyroxin, TSH, thyroid antibodies, anti-thyroglobulin antibodies, and antithyroid peroxidase antibodies) in all participants indicated thyroid autoimmunity in three (5%) patients and this is comparable with the result obtained by Kordonouri et al. [20], who reported that the frequency of thyroid disease in T1DM in Germany is 10%.

However, Piątkowsk et al. [21] reported that 14.5% of children from Poland have autoimmune thyroid disease.


  Conclusion Top


Screening for celiac disease, thyroid disease, and H. pylori infection at diagnosis of T1DM is important, and rescreening should be performed at regular intervals for the negative cases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Škerblom HK, Vaarala O, Hyöty H, Ilonen J, Knip M. Environmental factor in the etiology of type 1 diabetes. Am J Med Genet 2002; 115:18–29.  Back to cited text no. 1
    
2.
Notkins AL, Lernmark A. Autoimmune type 1 diabetes: autoantibodies against insulin in type 1 diabetes. J Clin Invest 2001; 108:1247–1252.  Back to cited text no. 2
    
3.
Kordonouri O, Deiss D, Danne T, Dorow A, Bassir C, Gruters-Kieslich A. Predictively of thyroid autoantibodies for the development of thyroid disorders in children and adolescents with type 1 diabetes. Diabetic Med 2002; 169:5168–5216.  Back to cited text no. 3
    
4.
Hansen D, Bennedbaek FN, Hoier-Madsen M, Hegedus L, Jacobsen BB. Prospective study of thyroid function, morphology and autoimmunity in young patients with type 1diabetes. Eur J Endocrinol 2003; 1648:245–251.  Back to cited text no. 4
    
5.
Woodward M, Morrison C, Mccoll K. An investigation into factors associated with Helicobacter pylori infection. J Clin Epidemiol 2000; 53:175–181.  Back to cited text no. 5
    
6.
Gulcelik NE, Kaya E, Demirbas B, Culha C, Koc G, Ozkaya M, et al. Helicobacter pylori prevalence in diabetic patients and its relationship with dyspepsia. J Endocrinal Invest 2005; 28:214–217.  Back to cited text no. 6
    
7.
Centers for Disease Control and Prevention (CDC). National Centers for Health Statistics. National Center for Health; 2000. Available at: http://www.cdc.gov.nchs. [Last accessed 2017 Jan 28].  Back to cited text no. 7
    
8.
Oh MS. Evaluation of renal function, water, electrolytes and acid-base balance. In: McPherson RA, Pincus MR. editors. Henry's clinical diagnosis and management by laboratory methods. 22nd ed. Philadelphia, PA: Elsevier Saunders; 2011. p. 124–143.  Back to cited text no. 8
    
9.
Xiang Y, Liu Y, Lee M. Ultra high pressure liquid chromatography using elevated temperature. J Chromatogr 2006; 1104:198–202.  Back to cited text no. 9
    
10.
Stockig J. Assessment of thyroid function: towards an integrated laboratory-clinical approach. Clin Biochem Rev 2003; 24:109–122.  Back to cited text no. 10
    
11.
Koop I, Iichmann R, Izzil M. Detection of autoantibodies against tissue transglutaminase in children with coeliac disease. Am J Gastroenterol 2000; 95:2009–2014.  Back to cited text no. 11
    
12.
Chey WD. American College of Gastroenterology Guideline of Helicobacter pylori infection. Am J Gastroenterol 2007; 102:1808–1828.  Back to cited text no. 12
    
13.
Yakoob J, Abid S, Abbas A. Significance of cag A status and vac A subtypes of Helicobacter pylori in determining gastric histopathology in Pakistan. Helicobacter 2008; 12:417.  Back to cited text no. 13
    
14.
Ables AZ, Bouknight PJ, Bendyk H, Alsip R, Williams J, Beagle R. Standardized blood glucose control in non-critically ill patients is associated with a decreased length of stay. Published ahead of print in the Journal for Healthcare Quality 2016; 38:e89-96.  Back to cited text no. 14
    
15.
Ojetti V, Pitocco D, Ghirlanda G, Gasbarrini G, Gasbarrini A. Role of Helicobacter pylori infection in insulin-dependent diabetes mellitus. Minerva Med 2001; 92:137–144.  Back to cited text no. 15
    
16.
Marrollo M, Latella G, Melideo M. Increased prevalence of Helicobacter pylori in patients with diabetes mellitus. Dig Liver Dis 2001; 33:21–29.  Back to cited text no. 16
    
17.
Demir S, Gokturk NA, Ozturk A, Kulaksizoglu M, Serin E, Yilmaz U. Helicobacter pylori prevalence in diabetes mellitus patients with dyspeptic symptoms and its relationship to glycemic control and late complications. Dig Dis Sci 2008; 53:2646–2649.  Back to cited text no. 17
    
18.
Anastasios R, Goritsas C, Papamihail C. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. Eur J Intern Med 2002; 13:376.  Back to cited text no. 18
    
19.
Jaeger C, Hatziagelaki E, Petzoldt R, Bretzel RG. Comparative analysis of organ-specific autoantibodies and coeliac disease-associated antibodies in type 1 diabetic patients, their first-degree relatives, and healthy control subjects. Diabetes Care 2001; 24:27–32.  Back to cited text no. 19
    
20.
Kordonouri O, Klinghammer A, Lang EB. Thyroid autoimmunity in children and adolescents with type 1 diabetes: a multicenter survey. Diabetes Care 2002; 25:1346–1350.  Back to cited text no. 20
    
21.
Piątkowsk S, Szalecki A. Autoimmune thyroiditis in children and adolescents with type 1 diabetes. Pediatr Endocrinol Diabetes Metab 2011; 17:173–177.  Back to cited text no. 21
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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