Abstract
Celiac disease is a multisystem disease, and the liver is affected in a subset of patients. We herein present a case series of 25 patients with celiac disease who had evidence of cirrhosis of the liver. We retrospectively reviewed the case records of patients with celiac disease having concomitant cirrhosis. The diagnosis of celiac disease was made on the basis of the modified European Society of Pediatric Gastroenterology, Hepatology, and Nutrition criteria. Of 25 patients (nine males; mean age 28.8 ± 16.6 years) with celiac disease and cirrhosis, 17 patients presented predominantly with cirrhosis, while 8 presented primarily with celiac disease. Five patients had known cause of cirrhosis (autoimmune hepatitis, three; PBC, one; hepatic venous outflow tract obstruction, one); the remaining 20 were cryptogenic. Gluten-free diet led to improvement in diarrhea and anemia and to a better control of ascites and other features of liver failure. Some patients with cryptogenic cirrhosis have coexistent celiac disease, and they show response to gluten-free diet. Patients with cryptogenic cirrhosis should be screened for celiac disease.
References
Rewers M. Epidemiology of celiac disease: what are the prevalence, incidence, and progression of celiac disease? Gastroenterology. 2005;128:S47–51.
Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol. 2011;26:894–900.
Makharia GK, Baba CS, Khadgawat R, et al. Celiac disease: variations of presentations in adults. Indian J Gastroenterol. 2007;26:162–6.
Duggan JM, Duggan AE. Systematic review: the liver in coeliac disease. Aliment Pharmacol Ther. 2005;21:515–8.
Mounajjed T, Oxentenko A, Shmidt E, Smyrk T. The liver in celiac disease: clinical manifestations, histologic features, and response to gluten-free diet in 30 patients. Am J Clin Pathol. 2011;136:128–37.
Jacobsen MB, Fausa O, Elgjo K, Schrumpf E. Hepatic lesions in adult coeliac disease. Scand J Gastroenterol. 1990;25:656–62.
Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D. Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet. Hepatology. 1995;22:833–6.
Novacek G, Miehsler W, Wrba F, Ferenci P, Penner E, Vogelsang H. Prevalence and clinical importance of hypertransaminasaemia in coeliac disease. Eur J Gastroenterol Hepatol. 1999;11:283–8.
Volta U, De Franceschi L, Molinaro N, et al. Frequency and significance of anti-gliadin and anti-endomysial antibodies in autoimmune hepatitis. Dig Dis Sci. 1998;43:2190–5.
Kaukinen K, Halme L, Collin P, et al. Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure. Gastroenterology. 2002;122:881–8.
Logan RF, Ferguson A, Finlayson ND, Weir DG. Primary biliary cirrhosis and coeliac disease: an association? Lancet. 1978;1:230–3.
Ludvigsson JF, Elfstrom P, Broome U, Ekbom A, Montgomery SM. Celiac disease and risk of liver disease: a general population-based study. Clin Gastroenterol Hepatol. 2007;5:63–9. e1.
Mirzaagha F, Azali SH, Islami F, et al. Coeliac disease in autoimmune liver disease: a cross-sectional study and a systematic review. Dig Liver Dis. 2010;42:620–3.
Husby S, Koletzko S, Korponay-Szabo IR, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012;54:136–60.
Oberhuber G. Histopathology of celiac disease. Biomed Pharmacother. 2000;54:368–72.
Lindgren S, Sjoberg K, Eriksson S. Unsuspected coeliac disease in chronic 'cryptogenic' liver disease. Scand J Gastroenterol. 1994;29:661–4.
Sjoberg K, Lindgren S, Eriksson S. Frequent occurrence of non-specific gliadin antibodies in chronic liver disease. Endomysial but not gliadin antibodies predict coeliac disease in patients with chronic liver disease. Scand J Gastroenterol. 1997;32:1162–7.
Floreani A, Chiaramonte M, Venturini R, et al. Antigliadin antibody classes in chronic liver disease. Ital J Gastroenterol. 1992;24:457–60.
Villalta D, Girolami D, Bidoli E, et al. High prevalence of celiac disease in autoimmune hepatitis detected by anti-tissue tranglutaminase autoantibodies. J Clin Lab Anal. 2005;19:6–10.
Afredj N, Metatla S, Faraoun SA, et al. Association of Budd-Chiari syndrome and celiac disease. Gastroenterol Clin Biol. 2010;34:621–4.
Maki M. Coeliac disease: lack of consensus regarding definitions of coeliac disease. Nat Rev Gastroenterol Hepatol. 2012;9:305–6.
Conflict of interest
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Singh, P., Agnihotri, A., Jindal, G. et al. Celiac disease and chronic liver disease: Is there a relationship?. Indian J Gastroenterol 32, 404–408 (2013). https://doi.org/10.1007/s12664-013-0352-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12664-013-0352-z