title: Investigation into celiac disease in Indian patients with portal hypertension.
abstract: BACKGROUND
  There is limited data on celiac disease in patients with cryptogenic cirrhosis or idiopathic noncirrhotic intrahepatic portal hypertension (NCIPH). Our objective was to evaluate for celiac disease in patients with portal hypertension in India.
  
  
  METHODS
  Consecutive patients with portal hypertension having cryptogenic chronic liver disease (cases) and hepatitis B- or C-related cirrhosis (controls) were prospectively enrolled. We studied tissue transglutaminase (tTG) antibody and duodenal histology in study patients.
  
  
  RESULTS
  Sixty-one cases (including 14 NCIPH patients) and 59 controls were enrolled. Celiac disease was noted in six cases (including two NCIPH patients) as compared to none in controls. In a significant proportion of the remaining study subjects, duodenal biopsy showed villous atrophy, crypt hyperplasia, and lamina propria inflammation, not accompanied by raised intraepithelial lymphocytes (IELs); this was seen more commonly in cases as compared to controls. An unexpectedly high rate of tTG antibody positivity was seen in study subjects (66 %) of cases as compared to 29 % in controls (p-value < 0.001), which could indicate false-positive test result.
  
  
  CONCLUSIONS
  In this study, 10 % of patients with unexplained portal hypertension (cryptogenic chronic liver disease) had associated celiac disease. In addition, an unexplained enteropathy was seen in a significant proportion of study patients, more so in patients with cryptogenic chronic liver disease. This finding warrants further investigation.
authors.affiliation: Department of Gastrointestinal Sciences, Christian Medical College, Vellore, 632 004, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.forename: Ashish
authors.initials: A
authors.lastname: Goel
authors.forename: Anna B
authors.initials: AB
authors.lastname: Pulimood
authors.forename: Sudhir
authors.initials: S
authors.lastname: Babji
authors.forename: J
authors.initials: J
authors.lastname: Sophia
authors.forename: Chaya
authors.initials: C
authors.lastname: Prasad
authors.forename: K A
authors.initials: KA
authors.lastname: Balasubramanian
authors.forename: Banumathi
authors.initials: B
authors.lastname: Ramakrishna
authors.forename: Susy
authors.initials: S
authors.lastname: Kurian
authors.forename: G John
authors.initials: GJ
authors.lastname: Fletcher
authors.forename: Priya
authors.initials: P
authors.lastname: Abraham
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.forename: B S
authors.initials: BS
authors.lastname: Ramakrishna
authors.forename: Elwyn
authors.initials: E
authors.lastname: Elias
authors.forename: C E
authors.initials: CE
authors.lastname: Eapen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000906:Antibodies / Q000097:blood; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications*; D002648:Child; D004386:Duodenum / Q000473:pathology; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006521:Hepatitis, Chronic / Q000097:blood / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000150:complications*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011503:Transglutaminases / Q000097:blood; D055815:Young Adult
chemical_list: D000906:Antibodies; D011503:Transglutaminases