Prevalence of celiac disease in cirrhosis and outcome of cirrhosis on a gluten free diet: a prospective study.
OBJECTIVE
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.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States. Electronic address: Fleminj1@ccf.org.
Jamile
J
Wakim-Fleming
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States.
Mangesh R
MR
Pagadala
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States.
Arthur J
AJ
McCullough
Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States.
Rocio
R
Lopez
Anatomic Pathology, Cleveland Clinic, Cleveland, OH, United States.
Ana E
AE
Bennett
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States.
David S
DS
Barnes
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, United States.
William D
WD
Carey
D000328:Adult; D000368:Aged; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000276:immunology; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007421:Intestine, Small / Q000473:pathology; D008099:Liver / Q000201:enzymology; D008103:Liver Cirrhosis / Q000150:complications* / Q000178:diet therapy* / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology; D016896:Treatment Outcome
D007070:Immunoglobulin A; D011503:Transglutaminases
Celiac disease; Celiac serology; Cirrhosis; Endomysial antibody; Human tissue transglutaminase; Marsh