Anti-Tissue Transglutaminase Antibodies in Patients with Abnormal Liver Tests: Is It Always Coeliac Disease?

Iacono, Oreste Lo; Petta, Salvatore; Venezia, G.; Marco, Vito Di; Tarantino, Giuseppe; Barbaria, F.; Mineo, Claudia; Lisi, S. De; Almasio, Piero Luigi; Craxı̀, Antonio

doi:10.1111/j.1572-0241.2005.00244.x

Cited by 62 publications

(47 citation statements)

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“…The liver blood test abnormalities observed in patients with nonalcoholic fatty liver disease and CD normalized after 6 months of a GFD. 74,75 The effect of a GFD on the reversal of histological abnormalities in nonalcoholic fatty liver disease remains to be elucidated.…”

Section: Nonalcoholic Fatty Liver Diseasementioning

confidence: 99%

“…74 Another study of 121 patients with biopsy-proven nonalcoholic fatty liver disease found that the prevalence of CD in patients with nonalcoholic fatty liver disease was 3.3%. 75 Impact of Gluten Withdrawal on Liver Disease. The liver blood test abnormalities observed in patients with nonalcoholic fatty liver disease and CD normalized after 6 months of a GFD.…”

Section: Nonalcoholic Fatty Liver Diseasementioning

confidence: 99%

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The liver in celiac disease

2007

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Celiac disease is a common (1% prevalence) chronic immune-mediated disorder of the small intestine induced by dietary wheat, barley, and rye. Several hepatic disorders have been described in association with celiac disease. Isolated hypertransaminasemia with nonspecific histologic changes in a liver biopsy is the commonest hepatic presentation of celiac disease. A gluten-free diet normalizes liver enzymes and histologic changes in most patients. Moreover, celiac disease can coexist with autoimmune liver disorders such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Celiac disease has increasingly been reported with a variety of other liver diseases. Thus, the hepatologist needs to consider celiac disease in the differential of abnormal liver blood tests and to be aware of the clinical implications of this frequent disease in patients with liver disorders. The possible mechanisms of liver injury and those common factors that explain the association of celiac disease with liver disorders are discussed. The aims of this article are (1) to review the spectrum and pathogenesis of liver injury related to celiac disease and (2) to provide direction to those caring for patients with chronic liver diseases regarding the detection and effective treatment of celiac disease. (HEPATOLOGY 2007;46:1650-1658

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Section: Nonalcoholic Fatty Liver Diseasementioning

confidence: 99%

Section: Nonalcoholic Fatty Liver Diseasementioning

confidence: 99%

The liver in celiac disease

2007

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“…Çölyak hastalarında tanı sırasında hastaların yaklaşık % 30'unda geçici transaminaz yükseklikleri olduğu bildirilmiştir [16,17]. Etyolojisi açıklanamayan kronik karaciğer enzim yüksekliği olan hastalarda sessiz çölyak hastalığı prevalansı ise yaklaşık % 4 olarak bildirilmiştir [18]. Karaciğer hasarı çoğunlukla hafif transaminaz yüksekliği ve karaciğer biyopsisinde nonspesifik bulgular ile kendini gösteren, "çölyak hepatiti" olarak da adlandırılan tablo ile kendini gösterir.…”

Section: Discussionunclassified

Clinical and Laboratory Features and Extraintestinal Manifestations of Celiac Disease in Adults

Akın¹

2012

Ann Clin Anal Med

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ÖzetAmaç: Çölyak hastalığı, glutene karşı gelişen immün yanıt sonucu ortaya çıkan otoimmün bir hastalıktır. Erişkindeki başlangıç bulgu sıklıkla diyare olmakla birlikte anemi, osteoporoz, nonspesifik transaminaz yüksekliği ve gelişme geriliği gibi bazı ekstraintestinal bulgularla da ortaya çıkabilir. Bu yazıda, erişkin çölyak hastalarımızın başvuru semptomları, ekstraintestinal bulguları ve eşlik eden hastalıkları incelenmiştir. Gereç ve Yöntem: Ocak 2007 ile Eylül 2010 arasında Süleyman Demirel Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı'nda çölyak hastalığı tanısı ile takip edilen 22 hasta retrospektif olarak incelendi. Hastaların başvurusundaki semptomlar, ekstraintestinal bulgular ve eşlik eden hastalıklar değerlendirildi. Bulgular: Hastaların 13'ü (% 59) kadın, 9'u (% 41) erkekti. Tanıdaki ortalama yaş 38,5 yıldı. En sık başvuru yakınması ishal ve halsizlik-kuvvetsizlikti. Hastaların hepsinde doku transglutaminazı ve/veya antiendomisyum antikorları pozitifti ve tanı histopatolojik olarak doğrulanmıştı. 17 hastada (% 77) demir eksikliği, 8 hastada (% 36) vitamin B12 eksikliği ve 6 hastada folik asit (% 27) eksikliği vardı. 8 hastada (% 36) karaciğer enzim yüksekliği mevcuttu. 4 kadın ve 1 erkek hastada osteoporoz, 2 hastada sensorimotor polinöropati saptanmıştı. 2 hastada büyüme-gelişme geriliği mevcuttu. 2 hastada otoimmün hipotiroidi, 1 hastada Tip 1 diyabetes mellitus saptanmıştı. Bir hastada eş zamanlı Crohn hastalığı tanısı konulmuştu. Sonuç: Erişkinlerde çölyak hastalığı ekstraintestinal bulgular ile de ortaya çıkabilir. Özellikle nedeni açıklanamayan demir eksikliği anemisinde ve hafif-orta derecede transaminaz yüksekliklerinde çölyak hastalığı da akla getirilmelidir. Kronik diyaresi olan her hastada çölyak hastalığı da olabileceği düşünülmeli ve erken tanı ve uygun tedavi ile özellikle malabsorbsiyonun neden olduğu anemi, osteoporoz ve gelişme geriliği gibi komplikasyonlar önlenmelidir. Anahtar KelimelerÇölyak Hastalığı; Klinik Özellikler; Ekstraintestinal Bulgular Abstract Aim: Celiac disease an autoimmune disorder resulting from an immune response to the gluten in genetically predisposed patients. Although, diarrhea is the most common finding at presentation in adults, disease may present with extraintestinal manifestations such as anemia, osteoporosis, elevated transaminase levels and growth retardation. In this article, symptoms, extraintestinal manifestations and coexistence with other autoimmune disorders of adult patients with celiac disease were evaluated. Material and Method: 22 patients whose followed with the diagnosis of celiac disease in Suleyman Demirel University Department of Gastroenterology, between January 2007 and Semptember 2010, were evaluated retrospectively. Symptoms, extraintestinal manifestations and coexistence with other autoimmune disorders of patients at presentation were investigated. Results: 13 (59%) of all cases were female and 9 (41%) were male. Mean age at presentation was 38,5 years. Most common complaints were diarrhea and weakness . Tissue transglutam...

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“…Due to the estimated high prevalence of CD in patients with cirrhosis that is higher than in the general population [8,16,29,30] , and the potential reversibility of liver dysfunction on a gluten free diet, we recommend prompt consideration and exclusion of SB mucosal diseases and CD (by using a combination of laboratory, clinical, pathologic and genetic examinations, and response to a gluten free diet), when shortened villi, reversal of villus to crypt ratio or villus atrophy are seen in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

“…SB villus changes and atrophy are characteristic, but are not specific for coeliac disease [24,25] . Coeliac serological tests have low sensitivities and specificities in chronic liver disease and cirrhosis [15,[26][27][28][29] which emphasizes the importance of validating SB biopsy as the most important tool for the diagnosis of CD in this group of patients. Results of this study support the use of SB biopsy in patients with cirrhosis and portal hypertension when the diagnosis of CD is suspected.…”

Section: Discussionmentioning

confidence: 99%

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Wakim-Fleming¹,

Zein²,

Bennett³

et al. 2008

WJG

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INTRODUCTIONStudies of small bowel (SB) mucosa in cirrhosis and portal hypertension report a diverse spectrum of histological abnormalities [1][2][3][4][5] . These include increased capillary angiogenesis, mucosal edema, decreased villus to crypt ratio, villus atrophy and decreased total absorptive surface. Villus abnormalities resemble the abnormalities of coeliac disease (CD) and this may affect the interpretation of small bowel biopsy, and lead to confusion when CD is to be excluded in patients with cirrhosis and portal hypertension.The diagnosis of CD is increasingly considered and work up recommended during the evaluation of abnormal liver enzymes [6][7] . This is in part due to the heightened awareness of the association of CD with a variety of liver disorders. Most commonly described associated liver disorders include autoimmune hepatitis, primary biliary cirrhosis, non-alcoholic fatty liver disease, unexplained abnormal liver tests and cirrhosis [8][9][10][11][12][13][14][15] . The mechanisms of this association are not clear and the prevalence of CD in patients with liver disease is variable depending on the associated liver disease. For example, while CD affects 1% of the general population, one study reports that about 4% of 185 cirrhotic patients who had undergone liver transplantation were found to have CD, and 3 of 4 pa- Abstract AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis www.wjgnet.comWakim-Fleming J et al . Cirrhosis with portal hypertension does not cause atrophy of the small bowel mucosa 6371

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Anti-Tissue Transglutaminase Antibodies in Patients with Abnormal Liver Tests: Is It Always Coeliac Disease?

Cited by 62 publications

References 48 publications

The liver in celiac disease

The liver in celiac disease

Clinical and Laboratory Features and Extraintestinal Manifestations of Celiac Disease in Adults

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

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