Skip to main content
Log in

Frequency and Significance of Anti-gliadin and Anti-endomysial Antibodies in Autoimmune Hepatitis

Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Celiac disease has been associated withautoimmune disorders, but its frequency in autoimmunehepatitis is unknown. Sera from 157 patients with type1 autoimmune hepatitis, 24 patients with type 2autoimmune hepatitis, 62 patients with primary biliarycirrhosis, 30 patients with chronic hepatitis B, and 80patients with chronic hepatitis C were tested forimmunoglobulin A anti-endomysial antibodies by indirect immunofluorescence and immunoglobulin A and Gantibodies to gliadin by enzyme immunoassay. Duodenalbiopsy evaluation was recommended in patientsseropositive for immunoglobulin A anti-endomysialantibodies. Immunoglobulin A anti-endomysial antibodieswere present in eight of the 181 patients withautoimmune hepatitis (4%), including six with type 1disease (4%) and two with type 2 disease (8%).Immunoglobulin A antibodies to gliadin were found in six ofthese eight patients, but they were also present in twoothers, including one patient with chronic hepatitis C.Five of the eight patients with immunoglobulin A antiendomysial antibodies, including threepatients with no gastrointestinal symptoms, had duodenalbiopsies and subtotal villous atrophy was present in allof them. No patient with primary biliary cirrhosis or chronic viral hepatitis had antiendomysialantibodies. The presence of celiac disease in autoimmunehepatitis is high (at least one in 36 patients) and itis predominantly asymptomatic. Screening with anti-endomysial and anti-gliadin antibodiesshould be performed and results confirmed withintestinal biopsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Trier JS: Celiac sprue. N Engl J Med 325:1709 - 1719, 1991

    PubMed  Google Scholar 

  2. Volta U, Bianchi FB: IgA antibodies to endomysium, gliadin and reticulin in silent coeliac disease. Lancet 339:242, 1992

    Google Scholar 

  3. Ferguson A, Arranz E, O'Mahony S: Clinical and pathological spectrum of coeliac disease—active, silent, latent, potential. Gut 34:150 - 151, 1993

    PubMed  Google Scholar 

  4. Halsted CH: The many facets of celiac disease. N Engl J Med 334:1190 - 1191, 1996

    PubMed  Google Scholar 

  5. Collin P, Reunala T, Pukkala E, Laippala P, Keyrilainen O, Pasternack A: Coeliac disease: associated disorders and survival. Gut 35:1215- 1218, 1994

    PubMed  Google Scholar 

  6. Counsell CE, Taha A, Ruddell WSJ: Coeliac disease and autoimmune thyroid disease. Gut 35:844 - 846, 1994

    PubMed  Google Scholar 

  7. Rensch MJ, Merenich JA, Lieberman M, Long BD, Davis DR, McNally PR: Gluten-sensitive enteropathy in patients with insulin-dependent diabetes me llitus. Ann Intern Med 124:564 - 567, 1996

    PubMed  Google Scholar 

  8. Corazza GR, Andreani ML, Venturo N, Bernardi M, Tosti A, Gasbarrini G: Celiac disease and alopecia: Report of a new association. Gastroente rology 109:1333- 1337, 1995

    Google Scholar 

  9. Holmes GKT, Prior P, Lane MR, Pope D, Allan RN: Malignancy in coeliac disease—effect of a gluten free diet. Gut 30:333- 338, 1989

    PubMed  Google Scholar 

  10. McFarlane XA, Bhalla AK, Reeves DE, Morgan LM, Robertson DAF: Osteoporosis in treated adult coeliac disease. Gut 36:710 - 714, 1995

    PubMed  Google Scholar 

  11. Sher KS, Mayberry JF: Female fertility, obstetric and gynecological history in coeliac disease: A case control study. Digestion 55:243- 246, 1994

    PubMed  Google Scholar 

  12. Meyers S, Dikman S, Spiera H, Schultz N, Janowitz HD: Cutaneous vasculitis complicating coe liac disease. Gut 22:61- 64, 1981

    PubMed  Google Scholar 

  13. Brazier F, Delcenserie R, Sevestre H, Delamarre J, Capron JP. Primary sclerosing cholangitis and coeliac disease: Beneficial effect of gluten-free diet on the liver. Eur J Gastroenterol Hepatol 6:183- 186, 1994

    Google Scholar 

  14. Volta U, Molinaro N, Fusconi M, Cassani F, Bianchi FB. IgA antiendomysial antibody te st: A step forward in celiac disease screening. Dig Dis Sci 36:752- 756, 1991

    PubMed  Google Scholar 

  15. Lerner A, Kumar V, Iancu TC: Immunological diagnosis of childhood coeliac disease: comparison between antigliadin, antireticulin and antiendomysial antibodies. Clin Exp Immunol 95:78 - 82, 1994

    PubMed  Google Scholar 

  16. Lindberg J, Ahren C, Iwarson S: Intestinal villous atrophy in chronic active hepatitis. Scand J Gastroente rol 14:1015- 1018, 1979

    Google Scholar 

  17. Swarbrick ET, Fairclough PD, Campbe ll PJ, Levison DA, Greenwood RH, Baker LRI: Coeliac disease, chronic active hepatitis, and mesangiocapillary glome rulonephritis in the same patient. Lance t 2:1984 - 1985, 1980

    Google Scholar 

  18. Jacobsen MB, Fausa O, Elgio K, Schrumpf E: Hepatic lesions in adult coeliac disease. Scand J Gastroenterol 25:656 - 662, 1990

    PubMed  Google Scholar 

  19. Vajro P, Fontanella A, Maye r M, De Vincenzo A, Terracciano LM, D'Armiento M, Ve cchione R: Elevated serum aminotransferase activity as early manifestation of gluten-sensitive enteropathy. J Pediatr 122:416 - 419, 1993

    PubMed  Google Scholar 

  20. Logan RFA, Ferguson A, Finlayson NDC, Weir DG: Primary biliary cirrhosis and coeliac disease: An association? Lancet 1:230 - 233, 1978

    PubMed  Google Scholar 

  21. Iliffe GD, Owen DA: An association between primary biliary cirrhosis and jejunal villous atrophy resembling coeliac disease. Dig Dis Sci 24:802- 806, 1979

    PubMed  Google Scholar 

  22. Floreani A, Chiaramonte M, Venturini R, Plebani M, Martin A, Giacomini A, Naccarato R: Antigliadin antibody classe s in chronic liver diseases. Ital J Gastroente rol 24:457- 460, 1992

    Google Scholar 

  23. Olsson R, Kagevi I, Rydberg L: On the concurrence of primary biliary cirrhosis and intestinal villous atrophy. Scand J Gastroente rol 17:625- 628, 1982

    Google Scholar 

  24. Bassendine MF, Dewar PJ, James OFW: HLA-DR antigens in primary biliary cirrhosis: Lack of association. Gut 26:625- 627, 1985

    PubMed  Google Scholar 

  25. MacKay IR, Morris PJ: Association of autoimmune active chronic hepatitis with HLA-A1,-B8. Lance t 2:793- 795, 1972

    Google Scholar 

  26. Tighe MR, Hall MA, Cardi E, Ashkenazi A, Lanchbury JS, Ciclitira PJ: Associations between alleles of the major histocompatibility complex-encoded ABC transporter gene TAP2, HLA class II alleles, and ce liac disease susceptibility. Hum Immunol 39:9 - 16, 1994

    PubMed  Google Scholar 

  27. Czaja AJ: Diagnosis, prognosis and treatment of classical autoimmune chronic active hepatitis. InAutoimmune Live r Diseases. EL Kravitt, RH Wiesner (eds). New York, Raven Press, 1991, pp 143- 166

    Google Scholar 

  28. Johnson PJ, McFarlane IG, Alvarez F, Bianchi FB, Bianchi L, Burroughs A, Chapman RW, Czaja AJ, De smet V, Edleston ALWF, Ge rber MA, Hoofnagle JH, Kakumu S, MacSween RNM, Maddre y WC, Manns MP, Meyer zum Buschenfe lde KH, Mieli-Vergani G, Portmann BC, Re ed WD, Schalm SW, Scheuer PJ, Toda G, Tsuji T, Tygstrup N, Ve rgani D, Zeniya M: Mee ting report: International Autoimmune Hepatitis Group. Hepatology 18:998 - 1005, 1993

    PubMed  Google Scholar 

  29. Czaja AJ, Manns MP: The validity and importance of subtypes of autoimmune hepatitis: A point of view. Am J Gastroenterol 90:1206 - 1211, 1995

    PubMed  Google Scholar 

  30. Sherlock S: Primary biliary cirrhosis. InDiseases of the Liver and Biliary System, (8th ed.) S Sherlock, (ed). Oxford, Blackwell Scientific Publications, 1989, pp 273- 288

    Google Scholar 

  31. Volta U, Lenzi M, Lazzari R, Cassani F, Collina A, Bianchi FB, Pisi E: Antibodies to gliadin detected by immunofluorescence and a micro-ELISA me thod: marke rs of active childhood and adult coeliac disease. Gut 26:667- 671, 1985

    PubMed  Google Scholar 

  32. Volta U, Molinaro N, De Franceschi L, Fratangelo D, Bianchi FB: IgA anti-endomysial antibodies on human umbilical cord tissue for coe liac disease scree ning: Save both money and monkeys. Dig Dis Sci 40:1902- 1905, 1995

    PubMed  Google Scholar 

  33. Volta U, Molinaro N, De Franceschi L, Bianchi FB: Human umbilical cord as substrate for IgA antiendomysial antibodies allows large scale scree ning for celiac sprue. J Clin Gastroenterol 23:18 - 20, 1996

    PubMed  Google Scholar 

  34. Roy-Choudhury DC, Cooke WT, Tan DT, Banwell JG, Smits BJ: Jejunal biopsy: Criteria and signifi cance. Scand J Gastroente rol 1:57- 74, 1966

    Google Scholar 

  35. Terasaki PI, McClelland JD: Microdroplet assay for human serum cytotoxin. Nature 204:998 - 1000, 1964

    Google Scholar 

  36. Lindgren S, Sjoberg K, Erikson S: Unsuspected coe liac disease in chronic “Ccryptogenic” liver disease. Scand J Gastroente rol 29:661- 664, 1994

    Google Scholar 

  37. Maki M, Huupponen T, Holm K, Hallstrom O: Seroconve rsion of reticulin antibodies predicts coe liac disease in insulin dependent diabete s me llitus. Gut 36:239 - 242, 1995

    PubMed  Google Scholar 

  38. Maki M, Holm K, Lipsanen V, Hallstrom O, Viander M, Collin P, Savilahti E, Koskimies S: Serological marke rs and HLA genes among healthy fi rst degre e re latives of patients with coeliac disease. Lancet 338:1350 - 1353, 1991

    Article  PubMed  Google Scholar 

  39. 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 22:833- 836, 1995

    Article  PubMed  Google Scholar 

  40. Catassi C, Ratsch IM, Fabiani E, Rossini M, Bordicchia F, Cande la F, Coppa GV, Giorgi PL: Coeliac disease in the year 2000: exploring the iceberg. Lancet 343:200 - 203, 1994

    Article  PubMed  Google Scholar 

  41. Volta U, Bonazzi C, Bianchi FB, Baldoni AM, Zoli M, Pisi E: IgA antibodies to dietary antigens in liver cirrhosis. Ric Clin Lab 17:235- 242, 1987

    PubMed  Google Scholar 

Download references

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

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 43, 2190–2195 (1998). https://doi.org/10.1023/A:1026650118759

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1026650118759

Navigation