Association of coeliac disease with primary biliary cirrhosis in Poland.
OBJECTIVE
In western and northern but not southern Europe, the prevalence of coeliac disease among patients with primary biliary cirrhosis (PBC) is higher than in the general population. We analysed the prevalence of coeliac disease among patients with PBC in Poland, a central European country.


METHODS
In 115 patients with PBC, immunoglobulin A (IgA) antibodies against guinea-pig tissue transglutaminase (tTGA), monkey endomysium (EMA) and gliadin (AGA) were determined. In patients positive for tTGA and/or EMA, the DNA typing of HLA-DQB gene and small-bowel biopsy were performed.


RESULTS
IgA EMA was found in one patient with PBC (0.9%, 95% CI 0-2.5%). tTGA was detected in seven patients (6%, 95% CI 1.8-10.3%). Small-bowel biopsy showed flat mucosa in one subject, who was EMA positive/tTGA negative/AGA negative, and normal histology in four tTGA-positive/EMA-negative patients. In the latter four patients, the positive tTGA result was caused by IgA reactivity to proteins other than transglutaminase. Prevalence of coeliac disease in our 115 patients with PBC was 0.9% (95% CI 0-1.9%). In one patient with silent coeliac disease presenting with the HLA-DQ2 allele, introduction of a gluten-free diet was followed by improvement in liver function tests, improvement in histology of the distal duodenum, and disappearance of EMA.


CONCLUSIONS
Our results from Poland do not confirm a high prevalence of coeliac disease in PBC patients. Guinea-pig liver transglutaminase immunolinked assay cannot be used as a screening test for coeliac disease in PBC patients. A gluten-free diet may be helpful in restoration of liver function in patients with such an association.
Habior
Andrzej
A
Department of Gastroenterology, Medical Centre for Postgraduate Education, Medical Academy, W.K. Roentgen Str. 5, 02-781 Warsaw, Poland. ahab@coi.waw.pl
Lewartowska
Aleksandra
A
Orłowska
Janina
J
Zych
Włodzimierz
W
Sankowska
Monika
M
Bauer
Alicja
A
Butruk
Eugeniusz
E
D000328:Adult; D000368:Aged; D000906:Antibodies / Q000032:analysis; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D005903:Gliadin / Q000276:immunology; D006683:HLA-DQ Antigens / Q000235:genetics; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D008105:Liver Cirrhosis, Biliary / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011503:Transglutaminases / Q000276:immunology
D000906:Antibodies; D006683:HLA-DQ Antigens; D007070:Immunoglobulin A; D005903:Gliadin; D011503:Transglutaminases