Endocrine Abstracts

JOINT2343

Introduction: Children and adolescents with type 1 diabetes (T1D) have an increased risk to develop other autoimmune diseases. Autoimmune gastritis (AIG) is the third most frequent autoimmune comorbidity in T1D adults, while few data are available for children.

Objectives: Single-center, cross-sectional, observational study aimed to evaluate the prevalence of serum anti-parietal cell antibodies (APCA) and its related clinical alterations in children and adolescents with T1D.

Methods: Data on APCA assay [positive (+) or negative (-)], autoantibodies against β-cells at T1D onset (IAA, GAD, ICA) and other organ-specific autoantibodies, AIG-related symptoms (dyspepsia, abdominal pain and early postprandial satiety), anaemia, and mean corpuscular volume (MCV) alterations were recorded (last annual routine outpatients visit). In confirmed APCA(+) subjects, additional laboratory tests [iron, vitamin B12, chromogranin A, gastrin-17, and intrinsic factor autoantibodies (IFAs)] and gastrointestinal endoscopy (GE) were performed.

Results: 146 patients with T1D were recruited [54. 1% males, 70% Caucasian, mean age 14. 5±3. 55 yrs, T1D duration 8. 36±4. 01 yrs, A1c 60±15 mmol/l]. Eight out of 146 subjects were APCA(+) (prevalence 5. 5%). APCA(+) subjects, compared to APCA(-) ones, had a higher prevalence of AIG symptoms (P < 0. 001), thyroid autoimmunity (P = 0. 002), and combination of IAA+GAD autoantibodies at T1D onset (P < 0. 001) (Table). They also had a trend towards a higher prevalence of anaemia (P = 0. 054). In APCA(+) subjects we found anaemia (25%), microcytosis (25%), iron deficiency (37. 5%), vitamin B12 deficiency (57. 1%), high levels of gastrin-17 (28. 6%) and chromogranin A (42. 9%). None was positive for IFAs. Lastly, 6 out of 8 APCA(+) patients underwent GE: 2 subjects showed endoscopic features of AIG (thinned and oedematous areas of the gastric antrum and corpus mucosa). Histological examination identified signs of chronic gastric mucosal inflammation in all patients (4 mild and non-specific alterations, indicating early stages of AIG; 1 marked alterations in glandular structure; 1 advanced AIG and discrete mucosal atrophy).

Conclusions: The prevalence of APCA(+) we found in our youths with T1D was 5. 5%, consistent with findings from few available previous studies. In contrast, we didn’t found a higher prevalence in females. Our data suggest the usefulness of a regular screening for AIG, mainly in patients with thyroid autoimmunity, IAA+GAD at T1D onset, and AIG symptoms. The early is the diagnosis, the early is the treatment of its related symptoms and deficiencies.