738 Written informed parental consent was obtained. The diagnosis of CD was made following the European Society for Pediatric Gastroenterology and Nu- trition criteria. 8 All patients underwent HLA antigen class I and II serological typing. In 85 patients, genomic analysis of HLA- DQA1* and DQB1* exons 2 was performed with a polymerase chain re- action sequence-specific primer tech- nique 9 after DNA extraction; 162 bone marrow donors were used as controls. RESULTS We found 6 patients positive for EMA. Intestinal mucosal biopsy showed subtotal or partial villous atro- phy, crypt hyperplasia, and increased interstitial and intraepithelial lympho- cytes in all. Two patients had 2 succes- sive evaluations. At the first evaluation, 1 patient showed normal intestinal mu- cosa and a patchy distribution of intesti- nal atrophy with marked intraepithelial lymphocytes after 27 months. The other had a picture of infiltrative enteropathy when first examined and partial atro- phy with marked infiltration (92 in- traepithelial lymphocytes/100 epithelial cells) after 1 year of normal diet. In- Many autoimmune disorders can be as- sociated with celiac disease (CD), in- cluding autoimmune thyroid disease (ATD) (14% to 30% of patients). 1 The reverse occurrence of CD in ATD is less documented, 2,3 and evidence is limited to adults with ATD. CD can be asymptomatic or present minor or atypical symptoms; clinically manifest forms represent only a small propor- tion of all cases. 4,5 Patients with silent CD are at risk for complications that could be prevented by a gluten-free diet (GFD). 4-6 We studied the preva- lence of CD in children and adoles- cents affected by ATD. The copresence Celiac disease in children with autoimmune thyroid disease Daniela Larizza, MD, Valeria Calcaterra, MD, Costantino De Giacomo, MD, Annalisa De Silvestri, BS, Margherita Asti, BS, Carla Badulli, BS, Michele Autelli, BS, Eliana Coslovich, MD, and Miryam Martinetti, BS From the Dipartimento di Scienze Pediatriche, Univer- sità di Pavia, IRCCS Policlinico S. Matteo, Pavia, Italia; Divisione di Neonatologia e Patologia Neonatale, Servizio di Immunoematologia e Trasfusione e Centro di Immunologia dei Trapianti, Servizio di Analisi Biochimico Cliniche, IRCCS Policlinico S. Matteo, Pavia, Italia. Submitted for publication Dec 12, 2000; revi- sion received May 8, 2001; accepted June 14, 2001. Reprint requests: Daniela Larizza, MD, Di- partimento di Scienze Pediatriche, IRCCS Policlinico S. Matteo, P.le Golgi, 2, 27100 Pavia, Italia. Copyright © 2001 by Mosby, Inc. 0022-3476/2001/$35.00 + 0 9/22/118189 doi:10.1067/mpd.2001.118189 AT Autoimmune thyroiditis ATD Autoimmune thyroid disease CD Celiac disease EMA Antiendomysium antibodies GD Graves disease GFD Gluten-free diet of CD and ATD with the sharing of im- munogenetic predisposition markers was also investigated. 7 P ATIENTS AND METHODS Ninety children and adolescents (78 females, median age at diagnosis 11.07 years, range 1.8 to 17.3) with ATD were studied; 68 (58 females) had au- toimmune thyroiditis (AT), and 52 pa- tients were treated with replacement L-thyroxine. Twenty-two (20 females) were affected by Graves disease (GD), and 21 were treated with methimazole. Sixteen patients had other diseases or associated conditons: alopecia in 4; vi- tiligo in 2; juvenile rheumatoid arthritis in 2; autoimmune hepatitis, antiphos- pholipid antibodies syndrome, throm- bocytopenia, Raynaud phenomenon, discoid lupus, Down Syndrome, selec- tive IgA deficiency, and CD in 1, re- spectively. Screening for IgA antiendomysium antibodies (EMA) was performed in all patients. Positive patients underwent endoscopic examination of the upper gastrointestinal tract with at least 4 biopsies of the distal duodenal mucosa. Ninety children and adolescents with autoimmune thyroid disease were screened for celiac disease. All 90 patients were typed for HLA antigen class I and II and for HLA-DQA1 and DQB1 heterodimers. Celiac disease and DQA1*0501, DQB1*02 were found in 7 (7.8%) patients. The prevalence of celiac disease was 1 of 13. Screening for celiac disease is recommended in children with autoimmune thyroid disease. (J Pediatr 2001;139:738–40)