(2010). Matrix metalloproteinases. Curr Med Chem. 17(31):3751-68. **Section 2**

**Clinical Manifestations and Complications of Celiac Disease** 

68 Celiac Disease – From Pathophysiology to Advanced Therapies

Zitka, O., Kukacka, J., Krizkova, S., Huska, D., Adam, V., Masarik, M., Prusa, R. & Kizek, R.

**4** 

*1,2,3Poland 4UK* 

**Celiac Disease and Diabetes Mellitus Type 1** 

*1Clinic of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw,* 

A significant increase in autoimmune disease morbidity has been observed in recent years, including disorders manifesting in childhood, concurrent with decreased age of patients at the time of diagnosis. Autoimmune diseases can involve almost every organ system but the endocrine, connective tissue and gastrointestinal systems are the most

In terms of epidemiology, autoimmune thyroid diseases (AITD) and diabetes type 1 (T1DM) come to the fore among autoimmune diseases related to the endocrine system, whereas among those unrelated to the endocrine system celiac disease (CD) is one of the more common. These diseases, apart from bronchial asthma, are among the most frequent chronic

Autoimmune polyendocrinopathy syndrome (APS) or polyglandular autoimmune diseases (PGAD) concern primary deficits in two or more endocrine glands and manifest themselves, except for Graves' disease, as organ hypofunction. The main autoimmune endocrinopathies are: type 1 diabetes mellitus, autoimmune thyroid diseases, autoimmune adrenal failure (Addison disease), hypergonadotropic hypogonadism (premature ovarian failure), autoimmune hypoparathyroidism, and pituitary defects (lymphocytic hypophysitis) 5, 6, 7

Those syndromes are often associated with other non-endocrine autoimmune diseases 5, 6, 7. For descriptive purposes three to four different types of APS or PGAD have been described. Addison disease is a common element of the first two types i.e. APS-1 Blizzard syndrome, APS-2 Schmidt's syndrome (Carpenter's syndrome). APS-3, on the other hand, is characterised by the presence of autoimmune thyroid disease and diabetes type 1 (3a), pernicious anaemia (3b) or vitiligo, alopecia or other organ specific autoimmune disease

Some authors also distinguish type 4 disease/syndrome, which comprises varied combinations of autoimmune diseases with the exception of those mentioned above as types

1 and 2. A patient with diagnosed T1DM and CD can be included in this group 5, 6, 7.

diseases affecting infants and children and often occur together 1, 3 , 4.

**1. Introduction** 

(3c).

commonly affected 1, 2, 3.

*3Department of Pediatric Gastroenterology and Nutrition, Warsaw Medical University, 4Sport and Exercise Medicine, Oxford Deanery, Nuffield Orthopaedic Centre, Oxford,* 

Mieczysław Szalecki1,2, Piotr Albrecht3 and Stefan Kluzek4

*2Faculty of Health Sciences, Jan Kochanowski University, Kielce,* 
