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CWD, Orlando 2006. R Hanas, Dept of Pediatrics, Uddevalla Hospital, Sweden Why diabetes (type 1) and CD? Zonulin - keeping things in and out of order in the gut Zonulin - role in CD and diabetes Zonulin - role in the infant How common is celiac disease (CD)? The CD Iceberg Model Onset of celiac disease in first year of life Onset of celiac disease in first year of life Atypical symptoms of celiac disease Atypical symptoms of celiac disease CD and other diseases Celiac disease - the clinical reality Celiac disease - the clinical reality How do we suspect CD? Gastroscopic biopsy in children Gastroscopic biopsy A healthy mucosa with villi (“fingers”) Flat mucosa from patient with celiac disease The mucosa seen through a microscope Follow-up HbA1c and insulin requirements in children Hypoglycemia Celiac disease - what happens in the long run? Long-term health risks in untreated CD Cancer risks in untreated CD Happy without celiac diet? Risks with the diet? Can CD be treated with drugs?? To screen or not to screen for CD? Celiac disease and diabetes – open questions Whom to screen? When to screen? How often and for how long to screen? Is a second biopsy necessary, or can we rely on antibody results? What is the natural course of potential or silent CD(positive antibodies, positive biopsy)? Shall patients with latent or potential CD (positive antibodies, negative first biopsy) have repeated biopsies? How do we improve acceptance of GFD and compliance to GFD? Celiac Management Ragnar Hanas, MD, PhDDept. of Pediatrics, Uddevalla, Sweden Common genetic background(HLA-marker DQ2, DQ8)) Both have increased gut permeability (caused by a protein modulator called zonulin),present even in pre-diabetes (70%), several years before onset (in average 3.5 years).Sapone A. Diabetes 2006;55:1443-49. Allt fr?n Schober Early ( 3 months) introduction of gluten increased risk of developing diabetes 6- to 9-fold.Norris, JM. J Am Med Assoc 2003;290:1713-20. Ziegler AG. J Am M