Endocrine Abstracts

There is a well-recognised association between Coeliac disease and type 1 diabetes (T1DM). Four of our 68 patients have both conditions (5.9%). We present three other patients with T1DM and GI disease – two inflammatory bowel disease (IBD=2.9%) and one primary sclerosing cholangitis (PSC) and IBD (=1.5%).

Case 1: Sixteen years old male, with T1DM from 13-year-old, developed diarrhoea and abdominal pain with no weight loss or blood pr. Investigation showed microcytic anaemia, raised inflammatory markers and negative Coeliac screen. Colonoscopy revealed eosinophils, but repeat showed a pan-colitis. Diagnosis=Indeterminate colitis.

Case 2: Nine years old male, with T1DM from 2-year-old, developed lower abdominal pain and fluctuating bowel habit but with no blood pr. Negative Coeliac screen, normal FBC and LFTs but has iron deficiency and raised inflammatory markers. During surgery, for appendicitis, he was found to have mesenteric lymphadenopathy and a thickened ileum. Small bowel series was suggestive of terminal Crohn’s disease. Terminal ileal biopsies showed lymphoid nodularity (non-specific). Commenced on Pentasa, which controls his symptoms. Diagnosis=Possible terminal Crohn’s.

Case 3: Fifteen years old male, T1DM from 10-year-old, with abnormal LFTs on routine bloods. He is asymptomatic and anicteric. Liver biopsy was inconclusive but results of MRCP and MRI resulted in diagnosis of PSC. Despite being asymptomatic his colonoscopy showed a pan-colitis. Diagnosis=PSC and indeterminate colitis.

Conclusion: Coeliac disease is not the only GI condition seen in patients with T1DM. Previous reports have shown upto 10% of those with PSC have T1DM with about half being diagnosed prior to their liver disease. Patients with IBD have rates of T1DM upto 2.9% and there are recognised shared susceptibility loci. Remember when assessing new symptoms that autoimmune diseases often occur multiply. In our clinic 10.3% of patients have a GI co-morbidity of which 43% was IBD.