High Prevalence of Celiac Sprue among Patients with Primary Biliary Cirrhosis

Dickey, William; McMillan, S A; Callender, M. E.

doi:10.1097/00004836-199707000-00006

Cited by 94 publications

(48 citation statements)

References 17 publications

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“…Furthermore, the association between CD and autoimmune liver diseases is also a matter of debate (9,11,17,19,23,40,41,43,47,48). Several studies reported a firm link of CD with autoimmune cholestatic liver diseases, recommending screening for CD of patients with these disorders and vice versa (screening for PBC and/or PSC in patients with CD) (11,17,19,23,41,48).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

Germenis

Yiannaki

Zachou

et al. 2005

Clin Vaccine Immunol

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The prevalence of celiac disease (CD) and the prevalence and clinical significance of anti-tissue transglutaminase (tTG) antibodies (tTGAbs) in a large series of patients with chronic liver diseases were assessed. We studied 738 patients (462 with chronic viral hepatitis, 117 with autoimmune liver diseases, 113 with alcoholic or nonalcoholic fatty liver disease, and 46 with other liver disorders) and 1,350 healthy controls (HC). Immunoglobulin A (IgA) tTGAbs were measured by enzyme-linked immunosorbent assay and a microspherebased flow cytometric assay. Positive sera were investigated for IgA antiendomysial antibodies (EmA). IgA tTGAb-positive subjects were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Four of 1,350 HC (0.3%) tested tTGAb ؉ EmA ؉ and underwent a biopsy (CD confirmation in all). Four of 738 liver disease patients tested tTGAbs ؉ EmA ؉ (0.54%; not statistically significant). Two were HCV infected (1.24%; not statistically significant), and two had transaminasemia of unknown origin. Forty-three patients tested tTGAbs ؉ EmA ؊ (5.8%; P < 0.001 compared to HC). Inhibition experiments verified the existence of specific IgA anti-tTG reactivity. Twenty-six of 43 patients underwent a biopsy (all negative for CD). Binary logistic regression analysis revealed age (P ‫؍‬ 0.008), cirrhosis (P ‫؍‬ 0.004), alkaline phosphatase (P ‫؍‬ 0.026), and antinuclear antibodies (P ‫؍‬ 0.012) as independent risk factors for tTGAb reactivity among the patients. It was concluded that CD prevalence is the same in HC and patients with chronic liver diseases. The prevalence of tTGAbs is higher in hepatic patients compared to HC, but their specificity for CD diagnosis in this group of patients is low. tTGAbs in patients appear to be associated with the presence of autoimmunity, cirrhosis, and cholestasis, irrespective of the origin of the liver disease.Over the past few years, the identification of tissue transglutaminase (tTG) as the main, if not the sole, autoantigen recognized by antiendomysial antibodies (EmA) in celiac disease (CD) patients (12) allowed an increased number of asymptomatic and oligosymptomatic patients to be diagnosed and numerous associations of the disease with a range of conditions to be unveiled (15). Despite, however, the fact that the association between CD and various hepatic diseases has been extensively investigated (8, 9, 11, 16-19, 23, 26, 40, 41, 43, 45, 47, 48), a definite correlation between these pathological conditions has not been unequivocally established.Conflicting results have been reported that, at least in part, can be attributed to differences in the performance of serological tests used by different investigators for initial screening for CD. Patients with chronic liver diseases frequently have immunological and other disturbances, like hypergammaglobulinemia, that might interfere with the detection of serological markers for CD. Another reason underlying the discordant data may be related to the emergence of anti-tTG antibodies in some patients with chronic...

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

Germenis

Yiannaki

Zachou

et al. 2005

Clin Vaccine Immunol

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“…Liver blood tests did not improve in patients with silent CD and PBC after 12 to 24 months on a GFD despite the disappearance of the endomysial antibody in the serum. 30 Information regarding the stage of PBC in these patients, however, was not provided. 30 Pruritus and cholestasis did not improve after 12 months of gluten withdrawal in cases with PBC and severe liver disease [stage IV on histology (Scheuer's classification), with ALP elevations 3.1-4.8 times the upper limit of normal].…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

“…30 Information regarding the stage of PBC in these patients, however, was not provided. 30 Pruritus and cholestasis did not improve after 12 months of gluten withdrawal in cases with PBC and severe liver disease [stage IV on histology (Scheuer's classification), with ALP elevations 3.1-4.8 times the upper limit of normal]. These patients also were treated with ursodeoxycholic acid.…”

Section: Primary Biliary Cirrhosismentioning

confidence: 99%

“…34 The clinical impact on the liver of a GFD in patients with CD and early PBC [stages I-II on histology (Scheuer's classification), asymptomatic, with ALP elevations Ͻ 2 times the upper limit of normal] is yet to be determined. However, the early recognition and treatment of CD are recommended, as glu- Dickey et al 30 57 EmA 6 (11%) 4 (7%) Kingham et al 31 67 -4 (6%) 4 (6%) Gillett et al 32 378 tTGA, EmA 11 (2.6%) 5 (1.3%) Floreani et al 33 87 EmA 3 (3.4%) 3 (3.4%) Volta et al 34 173 tTGA, EmA 7 (4%) 7 (4%) Chatzicostas et al 35 62 tTGA, EmA 6 (10%) 0* Bardella et al 36 65 AGA, EmA 0 -Niveloni et al 37 10 AGA, EmA ten restriction improves the symptoms attributable to CD and can also reduce the risk of complications (malabsorption, osteoporosis, and malignant neoplasms). 44,45 Autoimmune Hepatitis (AIH) Prevalence.…”

Section: Primary Biliary Cirrhosismentioning

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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“…Among the complications related to celiac disease, many are worsened if the patient consumes in excess alcoholic beverages, for example, peripheral neuropathy (14,15) and epilepsy (16). Abnormal levels of aminotransferases (17) can be found in patients with celiac disease, as well as an association with several autoimmune chronic liver diseases such as primary biliary cirrhosis (18,19). There is also an increased risk of autoimmune cardiomyopathy (20,21).…”

Section: Introductionmentioning

confidence: 99%

Celiac disease and alcohol use disorders: increased length of hospital stay, overexpenditures and attributable mortality

Gili

Béjar

Ramírez

et al. 2013

Rev. esp. enferm. dig.

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Background and objectives: alcohol use disorders are associated with a greater incidence of certain comorbidities in patients with celiac disease. Currently there is no available information about the impact that these disorders may have on length of hospital stays, overexpenditures during hospital stays, and excess mortality in these patients.Methods: a case-control study was conducted with a selection of patients 18 years and older hospitalized during 2008-2010 in 87 hospitals in Spain. Estimations of excess length of stays, costs, and attributable mortality were calculated using a multivariate analysis of covariance, which included age, gender, hospital group, alcohol use disorders, tobacco related disease and 30 other comorbidities.Results: patients who had both celiac disease and alcohol use disorders had an increased length of hospital stay, an average of 3.1 days longer in women, and 1.7 days longer in men. Excess costs per stay ranged from 838.7 euros in female patients, to 389.1 euros in male patients. Excess attributable mortality was 15.1 % in women, 12.2 % in men.Conclusions: apart from a gluten-free diet and other medical measures, the prevention of alcohol abuse is indicated in these patients. Patients hospitalized who present these disorders should receive specialized attention after leaving the hospital. Early detection and treatment should be used to prevent the appearance of organic lesions and should not be solely focused on male patients.

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High Prevalence of Celiac Sprue among Patients with Primary Biliary Cirrhosis

Cited by 94 publications

References 17 publications

Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

Prevalence and Clinical Significance of Immunoglobulin A Antibodies against Tissue Transglutaminase in Patients with Diverse Chronic Liver Diseases

The liver in celiac disease

Celiac disease and alcohol use disorders: increased length of hospital stay, overexpenditures and attributable mortality

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