Autoimmune liver diseases in a paediatric population with coeliac disease - a 10-year single-centre experience.
BACKGROUND
Coeliac disease (CD) can be associated with liver disease. Gluten-free diet (GFD) normalizes cryptogenic forms, but most likely not autoimmune hepatitis (AIH). For this condition, immunosuppressants represent the treatment. However, when these are stopped, AIH generally relapses.


OBJECTIVE
To determine in CD children liver test abnormality frequency, the effect of GFD alone, or plus prolonged immunosuppressants on AIH course.


METHODS
Coeliac disease patients with abnormal transaminases were selected; if transaminases <5 x UNL (upper normal limits), GFD alone was administered; if >5 x UNL, liver examinations and biopsy were performed. In AIH, immunosuppressants were administered (5 years). Treatment was stopped only if patients remained in remission during the entire maintenance period and normalized liver histology.


RESULTS
A total of 140 out of 350 CD children had hypertransaminaemia: 133 cryptogenic disease, 7 AIH. GFD normalized only cryptogenic hepatitis. During treatment, all AIH persistently normalized clinical and biochemical parameters; after withdrawal, six patients maintained a sustained remission (follow-up range: 12-63 months), while one relapsed.


CONCLUSIONS
In CD children with AIH, only GFD plus immunosuppressants determines a high remission rate. When clinical remission is reached, a prolonged immunosuppressive regimen induces a high sustained remission rate after treatment withdrawal, indicating that this regimen may prevent early relapse.
Di Biase
A R
AR
Department of Pediatrics, University of Modena and Reggio Emilia, Italy.
Colecchia
A
A
Scaioli
E
E
Berri
R
R
Viola
L
L
Vestito
A
A
Balli
F
F
Festi
D
D
D000293:Adolescent; D001706:Biopsy; D002446:Celiac Disease / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D055050:Diet, Gluten-Free; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007223:Infant; D008111:Liver Function Tests; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D000637:Transaminases / Q000276:immunology*; D016896:Treatment Outcome
D000637:Transaminases