Celiac disease is found in 510% of patients with chronically abnormal liver tests and no obvious cause of liver disease.
The efficacy of screening for celiac disease by anti-tissue transglutaminase may be impaired by the high rate of it found in chronic liver disease.
Dr Oreste Lo Iacono and colleagues from Italy evaluated the prevalence of celiac disease.
The investigators and the role of anti-tissue transglutaminase in patients with non-viral, non-autoimmune chronic and no obvious cause of liver damage.
Out of 2512 consecutive patients with abnormal liver tests, 168 were included of which 118 were men, and 50 were women with a mean age of 41 years.
The team included the patients on the basis of clinical data and liver biopsy, as non-alcoholic fatty liver disease cryptogenic chronic hepatitis.
|Anti-tissue transglutaminase was positive in 20 out of 168|
|American Journal of Gastroenterology|
All were tested by recombinant immunoglobin-A and immunoglobin-G anti-tissue transglutaminase.
Patients with a positive serology underwent endoscopy with duodenal biopsies.
The investigators diagnosed non-alcoholic fatty liver disease in 121 patients, and 6 were associated with cirrhosis.
The team considered 47 patients as cryptogenic hepatitis in the absence of steatosis.
Anti-tissue transglutaminase was positive in 20 out of the 168 patients.
The team found celiac disease at endoscopy only in the 6 patients with both immunoglobin-A and immunoglobin-G anti-tissue transglutaminase positivity.
In addition, the investigators observed that 4 of the patients with celiac disease had non-alcoholic fatty liver disease.
The team noted that 2 of these were associated with cirrhosis, while 2 with cryptogenic hepatitis had celiac disease.
Dr Iacono's team concluded, “The prevalence of celiac disease in patients with chronically abnormal liver tests of unexplained etiology is 4%, with no relation with the degree of liver steatosis.”
“Screening should be done by testing for immunoglobin-A and -G antibodies and then evaluating by endoscopy and biopsy only patients positive for both.”