title: High levels of immunoglobulin A anti-tissue transglutaminase antibodies at diagnosis are a predictive factor for celiac hepatitis.
abstract: BACKGROUND
  Celiac hepatitis is characterized by the presence of liver injury in patients with celiac disease that resolves after gluten-free diet.
  
  
  OBJECTIVE
  To evaluate predictive factors of celiac hepatitis at celiac disease diagnosis.
  
  
  METHODS
  Retrospective study including 46 adult patients with the diagnosis of celiac disease.
  
  
  RESULTS
  Eighty-seven percent were women, with a mean age of 33 ± 11 years, 87% had a Marsh 3 and 46% (n = 21) had celiac hepatitis. These patients had a median Immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) level of 208.0 U/ml (p25-p75: 89-1316 U/ml), a mean aspartate aminotransferase of 42 ± 24 U/L, alanine aminotransferase 50 ± 28 U/L, alkaline phosphatase 111 ± 64 U/L, at the time of diagnosis. Median TTG-IgA one year after diagnosis was 9U/ml (p25-p75: 4.5-30.5 U/ml) and 33% of the patients had normal values. At diagnosis, patients without celiac hepatitis had a median TTG-IgA of 77U/ml (p25-p75: 24-288 U/ml), mean aspartate aminotransferase of 23 ± 4 U/L, alanine aminotransferase 20 ± 6 U/L, alkaline phosphatase 69 ± 17 U/L. Median of TTG-IgA one year after diagnosis was 6 U/ml (p25-p75: 3-19 U/ml) and 48% had normal values. The celiac hepatitis group patients had higher values of TTG-IgA (p = 0.007) at diagnosis. There was a statistically significant positive correlation between TTG-IgA and alanine aminotransferase (r = 0.324, p = 0.028) at diagnosis. The odds of having celiac hepatitis was almost 5-fold higher in patients with a TTG-IgA level higher than 310 U/ml (OR = 4.8, 95%CI = 1.213-18.781, p = 0.025).
  
  
  CONCLUSIONS
  Higher TTG-IgA levels are a predictive factor for celiac hepatitis in adult patients with celiac disease at diagnosis.
authors.affiliation: a Department of Gastroenterology , Centro Hospitalar São João , Porto , Portugal.
authors.forename: Andreia
authors.initials: A
authors.lastname: Albuquerque
authors.affiliation: a Department of Gastroenterology , Centro Hospitalar São João , Porto , Portugal.
authors.forename: Susana
authors.initials: S
authors.lastname: Rodrigues
authors.affiliation: a Department of Gastroenterology , Centro Hospitalar São João , Porto , Portugal.
authors.forename: Guilherme
authors.initials: G
authors.lastname: Macedo
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D002446:Celiac Disease / Q000175:diagnosis* / Q000473:pathology; D055050:Diet, Gluten-Free; D005260:Female; D019204:GTP-Binding Proteins / Q000276:immunology*; D006505:Hepatitis / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood*; D016015:Logistic Models; D008297:Male; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D011503:Transglutaminases / Q000276:immunology*; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D007070:Immunoglobulin A; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Celiac disease; celiac hepatitis; immunoglobulin A anti-tissue transglutaminase antibody