Arab J Gastroenterol. 2026 Aug 30:S1687-1979(26)00111-5. doi: 10.1016/j.ajg.2026.08.003. Online ahead of print.
ABSTRACT
BACKGROUND: Children with type 1 diabetes (T1D) have an elevated risk of celiac disease (CD), but region-specific prevalence estimates for the Eastern Mediterranean Region (EMR) are inconsistent and methodologically heterogeneous. So, we conducted a systematic review and meta-analysis to obtain a pooled estimate of CD in T1D children in EMR.
METHODS: A comprehensive search was conducted across three databases. Observational studies that assessed the prevalence of CD in children with diabetes (<18 years) in EMR were included. We assessed the quality of included studies with the JBI critical appraisal tool. Data extraction and assessment were guided by the PRISMA checklist. The primary outcome was pooled CD prevalence (seropositive and biopsy-confirmed). Publication bias and heterogeneity were assessed. The certainty of evidence was reported using the GRADE framework. Subgroup analysis of seropositive CD across countries in EMR and mean T1D duration.
FINDINGS: We identified 15 studies (N = 4740 type 1 diabetes children) from 8 countries -namely Saudi Arabia, Jordan, Iran, Iraq, Morocco, Egypt, Turkey, Oman. Of these, 7 were cross-sectional studies, 7 were cohort studies, and only one was a case-control study. No study from the remaining countries met our inclusion criteria. Among 4740 participants, the pooled seroprevalence of CD was 13% (95% CI: 0.10-0.15, I2 = 84%) and the biopsy-confirmed pooled prevalence was 7% (95% CI: 0.05-0.09, I2 = 42%). Pooled prevalence was higher for those with longer mean duration of T1D. Higher prevalence was observed in Saudi T1DM children. Study quality was generally low to moderate, and there was no publication bias in estimates. Overall certainty of evidence was graded as moderate for CD biopsy and low for seroprevalence.
CONCLUSIONS: CD prevalence in pediatric T1D in the EMR is substantially higher than population baselines, as 1 in 8 in T1DM seropositive children compared to 1 in 14 in biopsy-confirmed T1DM children. The prevalence varied across countries, supporting routine, repeated region-adapted screening.
PMID:42669575 | DOI:10.1016/j.ajg.2026.08.003
