Frequency and predictive factors for spontaneous normalization of anti-tissue transglutaminase-IgA serology among Saudi children with type 1 diabetes mellitus: A cohort study

Background: Celiac serology can be transiently elevated in patients with type 1 diabetes mellitus (T1DM) and normalized despite gluten consumption. This study aimed to identify the frequency and predictive factors of spontaneous normalization of anti-tissue transglutaminase (anti-TTG-IgA) antibodies in these patients. Methods: The charts of all patients (≤18 years) with T1DM were retrospectively reviewed from 2012 to 2021 at a tertiary care center in Riyadh, Saudi Arabia. The following data were collected: clinical characteristics of the participants, anti-TTG-IgA-immunoglobulin (Ig) A antibody, and histological findings. The outcome of positive anti-TTG-IgA-IgA in patients with T1DM and the predictive factors for spontaneous normalization were investigated. Results: Of the 1,006 patients with T1DM, 138 (13.7%) had elevated anti-TTG-IgA antibodies, celiac disease was diagnosed in 58/138 (42%) patients, spontaneous normalization of anti-TTG-IgA was observed in 65 (47.1%) patients, and fluctuating anti-TTG-IgA antibodies were seen in 15 (10.9%) patients. The patients with anti-TTG-IgA levels at 3–10 times the upper normal limits (UNL), and those with levels ≥10 times UNL were less likely to have spontaneous normalization of anti-TTG-IgA compared to patients with levels at 1–3 times UNL (hazard ratio [HR] = 0.28, 95% confidence interval [Cl] = 0.13–0.61, P = 0.001, and HR = 0.03, 95% Cl = 0.00–0.19, P < 0.001, respectively). Conclusion: Asymptomatic patients with T1DM with mild elevation of anti-TTG-IgA need not be rushed for invasive endoscopy or exposed to an un-needed gluten-free diet but should rather have a regular follow-up of their celiac serology

Fungal microbiota profile in newly-diagnosed treatment-naïve children with Crohn's disease

BACKGROUND & AIMS: although increasing evidence suggests a role for fungi in inflammatory bowel disease (IBD), data are scarce and mostly from adults. Our aim was to define the characteristics of fungal microbiota in newly-diagnosed treatment-naïve children with Crohn disease (CD). METHODS: The children referred for colonoscopy were prospectively enrolled in the study at King Khalid University Hospital, King Saud University and Al Mofarreh Polyclinics in Riyadh. Tissue and stool samples were collected and frozen till sequencing analysis. The children with confirmed CD diagnosis were designated as cases and the others as non- IBD controls. 78 samples were collected from 35 children (15 CD and 20 controls). Statistical analysis was performed to investigate CD associations and diversity. RESULTS: CD-associated fungi varied with the level of phylogenetic tree. There was no significant difference in abundance between normal and inflamed mucosa. Significantly abundant CD-associated taxa included Psathyrellaceae (p=0.01), Cortinariaceae (p= 0.04), Psathyrella (p= 0.004), and Gymnopilus (p=0.03).Monilinia was significantly depleted (p=0.03), whereas other depleted taxa, although not statistically significant, included Leotiomycetes (p= 0.06), Helotiales (p=0.08), Sclerotiniaceae (p=0.07). There was no significant difference in fungal diversity between CD and controls. CONCLUSIONS: We report highly significant fungal dysbiosis in newly diagnosed treatment naïve CD children. Depleted and more abundant taxa suggest anti-inflammatory and proinflamatory potentials respectively. Further studies with larger sample size including functional analysis are needed to clarify the significance of the fungal community in the pathogenesis of CD