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Testing for celiac disease suggested for cirrhotic patients
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Patients with cirrhosis and abnormal celiac serology could develop celiac disease, suggesting they should be screened for the disease, according to data from a new study.
Jamilé Wakim-Fleming, MD, department of gastroenterology and hepatology, Cleveland Clinic, and colleagues enrolled 204 cirrhotic patients (mean age, 55.4 years; 46% women) scheduled for upper endoscopy to treat gastroesophageal varices at Cleveland Clinic between May 2008 and May 2010. Patients with celiac disease (CD; n=5) were followed for 2 years after implementation of a gluten-free diet (GFD) to measure the prevalence of CD and the effect of GFD on the liver.
Jamile Wakim-Fleming
Twenty-two percent of patients were lost to follow-up; of those who were followed (n=159), 20% underwent liver transplantation, and 24% died.
Data indicated that 13.7% of the cohort had abnormal celiac serology and of those, 2.5% had CD with abnormal endomysial antibody levels (≥1/10). Among patients without CD, 85% displayed normal biopsy and normal serology. Of the five CD patients, one died before initiating GFD. The others on GFD showed normal levels of celiac serology, liver enzyme abnormalities and small bowel biopsy at 2 year follow-up, compared with levels before GFD. Three patients had improved MELD scores, and none of the patients received a liver transplant during or at follow-up. Human tissue transglutaminase levels and gliadin antibodies were higher in patients with CD compared with those without CD.
“Celiac disease is prevalent in cirrhosis, and cirrhotic patients should be screened for celiac disease,” Wakim-Fleming told Healio.com. “Even though a clinician may think the patient has hepatitis C or [nonalcoholic steatohepatitis]-related cirrhosis, for example, the patient could still have celiac disease in addition to hepatitis C or NASH. So unless they are tested for it, they are not going to know if they have it.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carlos Romero-Marrero, MD
The main finding is that this is the largest study looking at the prevalence of celiac disease in patients with cirrhosis. The study puts under the radar that in patients with cirrhosis, even in those with established causes for their liver disease, you should consider testing for celiac disease as you can potentially make a difference in the outcome and progression of the liver disease.
Even though we cannot conclude, considering the small sample size, that a gluten-free diet is what made the difference in the liver disease progression of patients with cirrhosis and celiac disease, it is reassuring that patients treated with a gluten-free diet improved with regard to their liver disease.
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