Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

Abstract

Introduction: Celiac disease is an autoimmune disorder that involves gluten intolerance and can be triggered by environmental factors including hepatitis B virus (HBV) infection. This study aimed to describe the prevalence of celiac disease in individuals with HBV infection and to describe the clinical and laboratory characteristics of celiac disease associated with HBV. Methods: This cross-sectional study included 50 hepatitis B patients tested for IgA anti-endomysial antibodies (EMAs) and tissue antitransglutaminase (TTG) between August 2011 and September 2012. Results: Fifty patients were included with a mean age of 46.0 ± 12.6 (46.0) years; 46% were female and 13% were HBeAg+. Six patients had positive serology for celiac disease, four were EMA+, and fi ve were TTG+. When individuals with positive serology for celiac disease were compared to those with negative serology, they demonstrated a higher prevalence of abdominal pain (100% vs. 33.3%, p = 0.008), lower median creatinine (0.7mg/dL vs. 0.9mg/dL, p = 0.007) and lower mean albumin (3.6 ± 0.4g/L vs. 3.9 ± 0.3g/L, p = 0.022). All individuals with positive serology for celiac disease underwent upper digestive endoscopy, and three of the patients exhibited a macroscopic pattern suggestive of celiac disease. Histologically, fi ve patients demonstrated an intra-epithelial lymphocytic infi ltrate level > 30%, and four patients showed villous atrophy associated with crypt hyperplasia on duodenal biopsy. Conclusions: An increased prevalence of celiac disease was observed among hepatitis B patients. These patients were symptomatic and had signifi cant laboratory abnormalities. These results indicate that active screening for celiac disease among HBV-infected adults is warranted.

A Study of Some Biochemical Indicators of Kidney Function and Estimation of Some Elements Concentration in the Blood Serum of Patients With Celiac Disease

“…In the results of the statistical analysis of the current study, the levels of urea, creatinine, and uric acid appeared close to normal levels, and some suffered from a slight increase in the levels of urea, creatinine and uric acid, and others in which the level of creatinine and uric acid decreased below the normal level in patients who take gluten, and this indicates the occurrence of disturbance in the function of the kidneys, which is an indication of the onset of celiac disease effect on kidney function .The results of the current study are in agreement with the study that showed a slight increase in the level of uric acid and a non-significant decrease in the level of creatinine in patients eating gluten compared to healthy subjects [9] .The results of the current study also agreed with the study in which glucose levels came within the normal range, but the levels of creatinine, urea and uric acid showed an increase from the normal range of the studied cases, as the researcher proved that there is a clear relationship between celiac disease and kidney disease [ 10 ] A study of celiac patients who also suffered from hepatitis B virus indicated that the creatinine level in some of the studied cases decreased below normal levels [11]. Another study showed that there is a high level of creatinine in patients with celiac disease and www.minarjournal.com kidney disease who eating gluten [6].…”

Serologic testing for celiac disease in young people with elevated transaminases

“…However, it is still a controversy as to whether viral hepatitis (HBV and HBC) is associated with CD (19)(20)(21)(22).…”

“…The association between CD and various liver diseases has been confirmed, including cryptogenic hypertransaminasemia, autoimmune liver disease (autoimmune hepatitis, primary sclerosing cholangitis, primary biliary cirrhosis), NAFLD, and nonalcoholic steatohepatitis (3). However, it is still a controversy as to whether viral hepatitis (HBV and HBC) is associated with CD (19)(20)(21)(22).…”

“…However, the previous reported studies showed obscure associations between HBV and CD. Two groups from southern Iran (19) and Brazil (20) showed that the prevalence of definite CD by duodenal biopsy in HBV patients was 5.4% and 9.1%, respectively, suggesting the necessity of screening for CD in patients with HBV. On the contrary, information from both Italy (21) and the Czech Republic (22) showed that none of the patients with HBV were diagnosed with CD, which was consistent with our findings.…”

Is screening for Celiac Disease Needed in Patients with Liver Disease?

“…Few studies have addressed the relationship between celiac disease and chronic hepatitis B [29,30], and the results are controversial. It has been demonstrated that vaccines against the hepatitis B virus are less efficacious in patients with celiac disease [31,32].…”