hospitals in the Netherlands. We retrospectively collected data of the moment of T1DMdiagnosis, CD diagnosis and comorbidity of autoimmune diseases. The diagnosis of T1DMwas defined as an absolute requirement of insulin and the diagnosis of CD was based oninternational criteria (ESPGHAN-criteria). Genomic DNA was obtained from peripheral bloodfor typing of HLA-DQA1* and DQB1* alleles, performed with a combined single strandedconformation polymorphism (SSCP/ heteroduplex method by a semi-automated electrophor-esis and gel staining method). Patients were divided in childhood onset of T1DM (onsetbefore 20 years) and adult onset of T1DM due to the fact that childhood onset of T1DMis strongly associated with HLA haplotypes. Results: The total group consisted of sixty-onepatients diagnosed with T1DM and CD (67.2% female) with a mean age of 41.5 ± 20.1years with a duration of T1DM and CD of 22.6 ± 16.8 years and 8.3 ± 10.4 years (P<0.01),respectively. All patients were unrelated and self-reported Dutch Caucasians. Patients carriedHLA-DQ2.5 in 80.3% (heterozygous in 50.8% and homozygous in 29.5%) of the cases.19.7% of the T1DM + CD patients were HLA-DQ2.5/DQ8. HLA-DQ8 heterozygous (withoutHLA-DQ2.5) was present in 16.4% of the cases and HLA-DQ8 homozygous in 3.3%. Only9.8% (6 of 61 patients) of the patients were diagnosed with CD before T1DM, 3 out of 6of them were HLA-DQ2.5 homozygous. In the childhood onset of T1DM group (n= 38)the age of T1DM onset was significantly lower in those who were HLA-DQ8 heterozygotesversus other genotypes (mean of 4.9 years versus 8.0 years (P<0.05). No associations betweenHLA-DQ type and the prevalence of autoimmune comorbidity or onset of CD were found.Conclusions: In patients with T1DM and CD a prevalence of carriers of HLA-DQ2.5 of80.3% is found. Interestingly, in the childhood onset group a younger age of onset of T1DMis associated with heterozygous HLA-DQ8. No associations were found between HLA-DQtype and the prevalence of autoimmune comorbidity or the onset of CD.

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Incidence of Small Bowel Pathology and Malabsorption in DermatitisHerpetiformis and Celiac DiseaseSuneeta Krishnareddy, Peter H. Green

Background: Dermatitis Herpetiformis (DH) is a dermatological manifestation of celiac disease(CD) that presents with a blistering rash and pathognomonic cutaneous IgA deposits. Recentstudies have shown an increasing incidence of DH, however the prevalence of small intestinalpathology and malabsorption in these patients is not clearly defined especially in the subsetof patients who present with DH compared to those who have concurrent DH but presentwith another clinical manifestation of celiac disease including anemia and osteoporosis.Methods: Ninety-eight patients with celiac disease and DH from our single institution wereanalyzed. Only patients who had data available from duodenal biopsy at time of diagnosiswere included in the analysis. A total of 84 patients (68 with other clinical manifestationof CD and concurrent DH and 16 with predominately DH) were included in analysis. Acomparison was made based on initial Marsh criteria in patients who presented with DHand those who were diagnosed with celiac disease from another clinical manifestation orscreening endoscopy who also happened to have DH. We also compared incidence of iron,B12, folate, and vitamin D deficiency in these two populations. Results: We divided smallbowel biopsy findings into two categories, those with Marsh 0, 1, or 2, and those withMarsh 3a, 3b, or 3c. The prevalence of significant small bowel pathology (Marsh 3a, 3b, or3c) was significantly higher in the patients who presented with another form of celiac diseasecompared to patients who presented with DH (33.8% vs. 12.5%, p=.01). There was nosignificant difference between the two groups in the incidence of iron (mean 81.4 +/- 25.5vs. 64.6 +/- 33.4, p=.11), B12 (mean 682.8 +/- 353.3 vs. 557.4 +/- 338.9, p=.26), folate(mean 12.49 +/-8.0 vs 10.24 +/-5.5 p=.43) or vitamin D (30.88 +/- 14.6 vs. 25.67 +/- 15.42,p=.37) deficiency. Conclusions: Patients who present with celiac disease and concurrentDH are more likely to have Marsh 3a or greater pathology compared to those with predomin-ately DH, the nutritional deficiencies are similar between the two groups. It is possible thatduodenal biopsy may be normal in patients with DH but there is still evidence of malabsorp-tion, possibly due to decreased mucosal absorptive function and/or villous atrophy of themore distal jejunum. It is therefore important that we continue to screen all patients withany form of celiac disease, including DH, for nutritional deficiencies and replete whennecessary, as the patchy nature of the disease can mislead the clinician as to the risks ofnutritional deficiency.

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Incidence of Autoimmune Diseases and Lymphoma in Patients With CeliacDisease and Dermatitis HerpetiformisSuneeta Krishnareddy, Lori A. Leslie, Peter H. Green

Background: Celiac disease (CD) is due to an abnormal immune reaction to gluten resultingin small intestinal inflammation and villous atrophy. Dermatitis herpetiformis (DH) is recog-nized as a skin manifestation of celiac disease, and is often the presenting and only complaintof people with CD. DH is considered to be due to a reaction of anti tissue transglutaminase(tTG) 3 produced in the intestine with tTG 3 in the skin and is considered to be anautoimmune manifestation of CD. The connection between celiac disease and other autoim-mune disease has been shown, especially type 1 diabetes, autoimmune thyroid disease,autoimmune liver disease, rheumatoid arthritis, Addison's disease, Sjogren's syndrome, andlymphoma, but these other autoimmune diseases have not been studied in relation to patientswith DH. Methods: We sought to study the incidence of other autoimmune diseases inthose patients with DH and celiac disease compared to those with CD and no DH whopresented with another clinical manifestation, such as anemia, osteoporosis, and routinescreening. One thousand fifty patients with CD were included in analysis from our singleinstitution. We separated these patients into those with DH and those without. We soughtto determine incidence rate of other autoimmune diseases and lymphoma in these twopopulations. We analyzed the results using chi-square analysis and Fisher's exact test whenapplicable. Results: A total of 190 patients with autoimmune disease without DH and 85with DH, with or without autoimmune disease were included in analysis. Our results showthat the overall incidence of autoimmune disease in patients with DH was not significantlydifferent than those with CD without DH (20.4% vs. 19.6%, p=.68). On further sub analysisno significant difference was noted in the incidence of rheumatoid arthritis (1.2% vs. 2.4%,

S-275 AGA Abstracts

p=.67), Sjogren's syndrome (1.2% vs. 5.7%, p=.18), Addison's disease (0% vs. 1.6%, p=.55), or autoimmune liver disease (3.7% vs. 2.2%, p=.68). However, there was a decreasedincidence of thyroid disease (11.8% vs. 51.1%, p=.0001) and type 1 diabetes (0% vs. 9.5%,p=.002) in patients with DH compared to those without. Lymphoma occurred at a similarrate in patients with DH and CD without DH (1.2% vs. 3.9%, p=.36). Conclusions: In thisanalysis of patients with and without DH from a single institution, patients had no differencein association with most other autoimmune disorders, and lymphoma. Patients with DHdid have a significantly lower incidence of type 1 diabetes and autoimmune thyroid disease.In the population of patients presenting with DH it is important to encourage a gluten freediet and continue routine screening similar to those presenting with other forms of celiacdisease, as the course of disease and future complications does not seem to be clinically dif-ferent.

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Celiac Disease is Rare Among Patients With Follicular Lymphoma, DiffuseLarge B-Cell Lymphoma, and Hodgkin Lymphoma: A Preliminary Report Fromthe Lymphoma SPORE Molecular Epidemiology ResourceAlberto Rubio-Tapia, Joseph A. Murray, Zachary S. Fredericksen, Mark Liebow, AhmetDogan, Thomas M. Habermann, Susan L. Slager, Brian K. Link, James R. Cerhan

Background & Aims: Individuals with celiac disease (CD) have a 3-fold increased risk ofnon-Hodgkin lymphoma, but there is relatively little information about the prevalence ofCD in patients with lymphomas other than T-cell lymphomas. We describe the prevalenceof CD in North American patients with the lymphoma subtypes of follicular (FL), diffuselarge B-cell (DLBCL), and Hodgkin (HL) lymphomas. Methods: Newly diagnosed FL (n=223), DLBCL (n=168) and HL (n=110) case patients were enrolled into the LymphomaSPORE Molecular Epidemiology Resource from 2002 to 2008. Clinic-based controls (n=425) were enrolled from patients coming to a pre-scheduled general medical examination.Serum was collected shortly after diagnosis and before treatment in case patients and at thetime of enrollment in controls. All participants answered a health questionnaire that includesself-reported data about prior clinical diagnoses including CD. Screening for CD was per-formed using a previously validated sequential serology testing paradigm: serum samplesfrom all participants were tested for immunoglobulin A tissue transglutaminase antibodies(sensitivity ~95%), and if above 3 U/ml, samples were tested for immunoglobulin A endomy-sial antibodies (specificity ~100%). There were two sources of information on CD diagnosis,serology results and self-reported data. Undiagnosed CD was defined by a positive immunog-lobulin A endomysial antibody. Overall prevalence of CD includes participants with eitherserologically detected CD (undiagnosed CD) or self-reported clinical diagnosis of CD. Results:Undiagnosed CD was found in 0.4% of FL (n=1), 0.6% of DLBCL (n=1), 0% of HL, and0.2% of controls (n=1). None of serologically detected CD cases self-reported a history ofCD at the time of enrollment. In addition, there were 2 FL cases and 2 controls who haveindicated they had been diagnosed with CD. The overall prevalence of CD was 1.3% in FL,0.6% in DLBCL, 0% in HL, and 0.7% in controls. Table 1 Conclusions: We found theprevalence of CD to be rare among patients with FL, DLBCL and HL in this white, NorthAmerican sample. This study does not support systematic screening for CD in newly dia-gnosed lymphoma patients with these specific lymphoma subtypes. A much larger samplesize would be required to establish a stable estimate for the association of CD with theselymphoma subtypes.Table 1. Summary of Demographics and Results

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Accuracy of the Antibodies Against Synthetic Deaminated Gliadin Peptides forthe Diagnosis of Celiac Disease in a General Community Hospital inArgentina: Are so Sensitive for Patients With Low Pretest Probability?Raquel González, José M. Mella, Adriana Mohaidle, Lisandro Pereyra, Carolina Fischer,Guillermo Nicolás Panigadi, Pablo Luna, Beatriz Vizcaino, Mario A. Medrano, Adrián R.Hadad, Marta Costa, Maria Cecilia Reyes, Patricia Domecq, Daniel G. Cimmino, Silvia C.Pedreira, Luis A. Boerr

Introduction: Serological tests have shown high diagnostic accuracy for celiac disease (CD)in selected populations. Although intestinal biopsy is still considered the gold standard fordiagnosis of CD, the antibodies against synthetic deaminated gliadin peptides (DGPs) arebeing used as screening tests. However, their usefulness remains controversial in our com-munity. Aim: To determine the diagnostic accuracy of both DPGs antibodies isotypes (IgAand IgG) for the diagnosis of celiac disease in a populationmostly with low pretest probability.Materials and methods: During the period 2008-2010, all patients with suspicious of CDattending a general community hospital were analyzed by a retrospective study. Using theLaboratory, Pathology and Endoscopy electronic databases, we identified patients that hadperformed an upper gastrointestinal endoscopy with duodenal biopsies and, at the sametime, that had done a DPG test for CD screening. Patients with previous diagnosis of CDwere excluded. The diagnostic accuracy of both DPGs antibodies was evaluated. The DPG

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