High Rates of Celiac Disease in Portal Hypertension Patients

Celiac.com 03/16/2015 - Researchers don't really have too much data on celiac disease in patients with cryptogenic cirrhosis or idiopathic noncirrhotic intrahepatic portal hypertension (NCIPH).

In India, a research team recently set out to look for celiac disease in patients with portal hypertension. The research team included Rakhi Maiwall, Ashish Goel, Anna B. Pulimood, Sudhir Babji, J. Sophia, Chaya Prasad, K. A. Balasubramanian, Banumathi Ramakrishna, Susy Kurian, G. and John Fletcher.

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For their study, the team enrolled 61 consecutive patients with portal hypertension having cryptogenic chronic liver disease, including 14 with NCIPH, along with 59 patients with hepatitis B- or C-related cirrhosis as control subjects.

They looked at tissue transglutaminase (tTG) antibody and duodenal histology in study patients. They found six cases of celiac disease, including two NCIPH patients, while they found none in control subjects.

Duodenal biopsies for a significant percentage of the remaining study subjects showed villous atrophy, crypt hyperplasia, and lamina propria inflammation, not accompanied by raised intraepithelial lymphocytes (IELs), far more commonly than in controls.

Study subjects with portal hypertension having cryptogenic chronic liver disease showed an unexpectedly high rate of tTG antibody positivity (66%), as compared to 29% in controls (p-value < 0.001), which could indicate false-positive test result.

This study showed that 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.

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