Celiac Disease and Portal Hypertension: A Causal Association or Just a Coincidence?

• Published in: Journal of clinical and experimental hepatology Vol. 10; no. 4; pp. 290 - 295
• Main Authors: Tanwar, Amit, Gupta, Gaurav K., Chauhan, Virender, Sharma, Deepak, Jain, Mukesh K., Bhardwaj, Hemendra, Jhajharia, Ashok, Nijhawan, Sandeep
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01.07.2020; Elsevier
• Subjects: celiac disease; chronic liver disease; noncirrhotic portal hypertension; Original; portal hypertension; AIH; tTG antibody; CD; portal hypertension; NCIPH; Ig G; EHPVO; NCPH; NCPF; Anti LKM; BCS; ANA; noncirrhotic portal hypertension; celiac disease; ASMA; chronic liver disease; CLD; c CLD; HLA; HBV; PHT; HBs Ag; Anti LKM, anti-liver kidney microsome antibody; CD, celiac disease; EHPVO, extrahepatic portal vein obstruction; Ig G, immunoglobulin G; HBV, hepatitis B virus; HLA, human leukocyte antigen; NCPF, noncirrhotic portal fibrosis; BCS, Budd–Chiari syndrome; PHT, portal hypertension; ASMA, anti-smooth muscle antibody; CLD, chronic liver disease; c CLD, cryptogenic chronic liver disease; HBs Ag, hepatitis B surface antigen; NCIPH, noncirrhotic idiopathic portal hypertension; ANA, anti-nuclear antibody; NCPH, noncirrhotic portal hypertension; tTG antibody, tissue transglutaminase antibody; AIH, autoimmune hepatitis
• ISSN: 0973-6883; 2213-3453
• DOI: 10.1016/j.jceh.2019.11.005

Celiac disease (CD) has been linked to portal hypertension (PHT) of varied etiology, but the causality association has never been proved. We aim to study the prevalence of CD in patients of PHT of different etiology. A prospective observational study was conducted from June 2017 to December 2018 involving all the cases of PHT of varied etiology. Consecutive patients of PHT with chronic liver disease (CLD) of defined etiology like ethanol, viral hepatitis (B or C), Budd–Chiari syndrome (BCS), autoimmune-related cirrhosis, and cryptogenic CLD (cCLD) (group A) and those with noncirrhotic PHT (NCPHT), which included noncirrhotic portal fibrosis (NCPF) and extrahepatic portal vein obstruction (EHPVO) (group B), were screened for CD by IgA anti-tTG antibody followed by duodenal biopsy in serology-positive patients. Out of a total of 464 patients, group A constituted 382 patients, CLD related to ethanol (155), cCLD (147), hepatitis B (42), hepatitis C (21), autoimmune (10), and BCS (7), whereas 82 patients were in group B with NCPF (64) and EHPVO (18). Total 29 patients were diagnosed with CD in both groups, 17 in group A (4.5%) and 12 in group B (14.6%). In group A, 13 patients with cCLD, two with HBV-related CLD, one with BCS, and one with autoimmune-related CLD were concomitantly diagnosed as CD. In group B, CD was diagnosed in 12 patients of NCPF (11) and EHPVO (1). Liver histology showed chronic hepatitis in two patients and was normal in three patients. CD is common in PHT of different etiology, especially in cCLD, NCPH and autoimmune hepatitis; however, the etiological basis for this association is still to be defined. The likelihood of CD is higher in liver disease than the general population, and these patients should be screened for CD.