How Common is Celiac Disease in Patients with Autoimmune Hepatitis?

Celiac.com 10/20/2014 - Researchers don’t have much data on rates of celiac disease in patients with autoimmune hepatitis (AIH). To better understand any connections between the two conditions, a Dutch research team recently set out to examine the rates of celiac disease in patients with autoimmune hepatitis.

Specifically, the team set out to investigate the relationship between AIH and celiac disease by assessing the prevalence of IgA tissue antitransglutaminase antibodies (TGA) and antiendomysium antibodies (EMA) in a large group of AIH patients.

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The research team N.M. van Gerven, S.F. Bakker, Y.S. de Boer, B.I. Witte, H. Bontkes, C.M. van Nieuwkerk, C.J Mulder, G. Bouma; and the Dutch AIH working group. They are variously affiliated with the Departments of Gastroenterology and Hepatology, Epidemiology and Biostatistics, and Medical Immunology at the VU University Medical Centre in Amsterdam, The Netherlands.

For the first step in their study, the team used TGA antibody serology to determine the frequency of celiac disease in a group of 460 AIH patients. The team conducted EMA screens on any patients showing TGA positivity.

They then used digital and written medical records to collect retrospective data on previously diagnosed celiac disease and patient characteristics, and compared those findings with archival data on the prevalence of celiac disease in the Netherlands. They found that six patients had a known history of celiac disease, but were currently in remission, as shown by negative TGA blood screens.

In addition, ten of the 460 AIH patients (2.2%) showed positive IgA TGA. Positive EMA antibodies in these patients served to confirm celiac disease diagnosis.

Overall, the team found celiac disease in 3.5% of AIH patients compared with just 0.35% in the general Dutch population (P<0.001).

Discounting patients with either a primary biliary cirrhosis or primary sclerosing cholangitis overlap, the team found celiac disease in 11 (2.8%) AIH patients. This is the largest serological study to examine connections between AIH and celiac disease, and shows that patients with AIH have rates of celiac disease that are higher than those of the general population, but not as high as some studies have suggested.

Still, the team advises doctors to consider the possibility of concurrent celiac disease in all AIH patients.

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