title: Autoimmune liver diseases in a paediatric population with coeliac disease - a 10-year single-centre experience.
abstract: 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.
authors.affiliation: Department of Pediatrics, University of Modena and Reggio Emilia, Italy.
authors.forename: A R
authors.initials: AR
authors.lastname: Di Biase
authors.forename: A
authors.initials: A
authors.lastname: Colecchia
authors.forename: E
authors.initials: E
authors.lastname: Scaioli
authors.forename: R
authors.initials: R
authors.lastname: Berri
authors.forename: L
authors.initials: L
authors.lastname: Viola
authors.forename: A
authors.initials: A
authors.lastname: Vestito
authors.forename: F
authors.initials: F
authors.lastname: Balli
authors.forename: D
authors.initials: D
authors.lastname: Festi
mesh_terms: 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
chemical_list: D000637:Transaminases