Prevalence of celiac disease in cirrhosis and outcome of cirrhosis on a gluten free diet: A prospective study

• Published in: Journal of hepatology Vol. 61; no. 3; pp. 558 - 563
• Main Authors: Wakim-Fleming, Jamile, Pagadala, Mangesh R, McCullough, Arthur J, Lopez, Rocio, Bennett, Ana E, Barnes, David S, Carey, William D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2014
• Subjects: Adult; Aged; Biopsy; Celiac disease; Celiac Disease - diet therapy; Celiac Disease - epidemiology; Celiac Disease - immunology; Celiac serology; Cirrhosis; Diet, Gluten-Free; Endomysial antibody; Female; Gastroenterology and Hepatology; Human tissue transglutaminase; Humans; Immunoglobulin A - blood; Intestine, Small - pathology; Liver - enzymology; Liver Cirrhosis - complications; Liver Cirrhosis - diet therapy; Liver Cirrhosis - enzymology; Male; Marsh; Middle Aged; Prevalence; Prognosis; Prospective Studies; Sensitivity and Specificity; Transglutaminases - immunology; Treatment Outcome; Human Leucocyte antigen; CD; Endomysial Antibody; Celiac serology; EGD; GFD; gluten free diet; human Tissue Transglutaminase; Gastroesophageal varices; hTTG; SB; Celiac disease; Cirrhosis; Small Bowel; Model for End stage Liver disease; MELD; EMA; Upper endoscopy; GEV; Marsh; HCV; Hepatitis C; HLA; Endomysial antibody; Human tissue transglutaminase
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2014.05.020

Background & Aims Current consensus suggests CD to be a multi-systemic disease that could affect any organ system including the liver. It remains under-diagnosed in the US and its prevalence and management in cirrhotic patients has not been studied. Our aim was (1) to estimate the prevalence of CD in cirrhosis, (2) to characterize cirrhotic patients with abnormal celiac serology and normal small bowel biopsy and (3) to evaluate the effect of a GFD on the liver. Methods A total of 204 consecutive patients with biopsy proven cirrhosis scheduled for an upper endoscopy (EGD) to assess and treat gastro-esophageal varices (GEV) at the Cleveland Clinic between 5/1/2008 and 5/30/2010 were enrolled in the study and followed for 2 years. Results CD affects 2.5% of cirrhotic patients and more than twice the prevalence in the general population. Abnormal EMA >1/10 and high hTTG levels >20 IU can be used to diagnose CD in cirrhosis. Sensitivities and specificities are 100% for EMA and 80% and 94% for hTTG, respectively. After a GFD, patients with CD showed a return to normal levels of their celiac serology, small bowel biopsy and liver enzyme abnormalities. Conclusions CD is at least twice more common in cirrhotic patients than in the general population and GFD improves liver tests. CD can occur coincidentally with other liver disorders and screening may be warranted during the evaluation of patients with cirrhosis. Abnormal EMA and high hTTG levels can be used to diagnose CD in cirrhosis.