Elevated Poster Presentation International Celiac Disease Symposium 2026

Coeliac disease autoimmunity and coeliac disease in the Environmental Determinants of Islet Autoimmunity pregnancy-to-childhood cohort study of Australian children at risk of type 1 diabetes (146843)

Rebecca Thomson 1 , Megan Penno 1 , Cynthia Kanagasundaram 2 , Jesse Ekin 3 , Kelly McGorm 1 , Tim Spelman 1 , Maria Craig 4 5 , Emma Hamilton-Williams 6 , John Wentworth 7 8 , Peter Colman 7 , Elizabeth Davis 9 10 11 , Leonard Harrison 3 , Aveni Haynes 9 11 , Tony Huynh 12 13 , Georgia Soldatos 14 15 , Jenny Couper 1 16 , Jason Tye-Din 3
  1. Robinson Research Institute and School of Medicine, College of Health, Adelaide University, Adelaide, SA, Australia
  2. Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  3. Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
  4. School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, NSW, Australia
  5. Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, NSW, Australia
  6. Frazer Institute, Faculty of Health, Medicine and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
  7. Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia
  8. St Vincent’s Institute of Medical Research, Fitzroy, VIC, Australia
  9. Children's Diabetes Centre, The Kids Research Institute Australia, Perth, WA, Australia
  10. Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, WA, Australia
  11. Paediatrics, UWA Medical School, The University of Western Australia, Perth, WA, Australia
  12. Department of Endocrinology and Diabetes, Queensland Children’s Hospital, South Brisbane, QLD, Australia
  13. Children’s Health Research Centre, Faculty of Medicine, The University of Queensland, South Brisbane, QLD, Australia
  14. Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
  15. Diabetes and Vascular Medicine Unit, Monash Health, Clayton, VIC, Australia
  16. Endocrinology and Diabetes Department, Women’s and Children’s Hospital, North Adelaide, SA, Australia

Coeliac disease (CD) is an immune-mediated enteropathy triggered by dietary gluten in genetically susceptible individuals and is more common in children with type 1 diabetes (T1D) and their relatives than in the general population. The Environmental Determinants of Islet Autoimmunity (ENDIA) Study is a prospective Australian pregnancy-to-childhood cohort of children with a first-degree relative with T1D. We describe CD autoimmunity (CDA) and CD in ENDIA children, including serology, diagnostic pathways, HLA genotypes, and overlap with islet autoimmunity (IA).

ENDIA enrolled unborn children or infants younger than 6 months with a first-degree relative with T1D. Participants were followed from pregnancy or infancy until 10 years, T1D diagnosis, or withdrawal. CDA was defined as at least two positive tissue transglutaminase antibody results collected at least 3 months apart. CD was defined as biopsy-proven disease (Marsh score ≥2) or fulfilment of ESPGHAN no-biopsy criteria. Children with persistent CDA and negative biopsy, with ongoing gluten consumption were classified as potential CD. Descriptive analyses were used.

The cohort comprised 1,473 children born between 2012-2020 (median age 8.9 years; range 6.1-13.7). Of the 1,270 children who underwent coeliac serology testing (86.2% of cohort), 205 (13.9%) had at least one positive coeliac serology result (tissue transglutaminase and/or deamidated gliadin peptide antibodies) or CD. CD was diagnosed in 70 children, including 55 biopsy-confirmed cases and 15 meeting ESPGHAN criteria. A further 29 children met the definition for CDA and 3 for potential CD, giving 102 children with CD, CDA, or potential CD. Preliminary HLA analyses showed enrichment of HLA-DQ2-associated DR3 haplotypes among children with CD (80%). Eighteen children had both T1D/IA and CD/CDA.

ENDIA provides a unique resource for studying the development of CDA and CD in children at increased autoimmune risk and will support investigation of early-life determinants of CD and its overlap with IA and T1D.