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.
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REFERENCES
Trier JS: Celiac sprue. N Engl J Med 325:1709 - 1719, 1991
Volta U, Bianchi FB: IgA antibodies to endomysium, gliadin and reticulin in silent coeliac disease. Lancet 339:242, 1992
Ferguson A, Arranz E, O'Mahony S: Clinical and pathological spectrum of coeliac disease—active, silent, latent, potential. Gut 34:150 - 151, 1993
Halsted CH: The many facets of celiac disease. N Engl J Med 334:1190 - 1191, 1996
Collin P, Reunala T, Pukkala E, Laippala P, Keyrilainen O, Pasternack A: Coeliac disease: associated disorders and survival. Gut 35:1215- 1218, 1994
Counsell CE, Taha A, Ruddell WSJ: Coeliac disease and autoimmune thyroid disease. Gut 35:844 - 846, 1994
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
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
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
McFarlane XA, Bhalla AK, Reeves DE, Morgan LM, Robertson DAF: Osteoporosis in treated adult coeliac disease. Gut 36:710 - 714, 1995
Sher KS, Mayberry JF: Female fertility, obstetric and gynecological history in coeliac disease: A case control study. Digestion 55:243- 246, 1994
Meyers S, Dikman S, Spiera H, Schultz N, Janowitz HD: Cutaneous vasculitis complicating coe liac disease. Gut 22:61- 64, 1981
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
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
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
Lindberg J, Ahren C, Iwarson S: Intestinal villous atrophy in chronic active hepatitis. Scand J Gastroente rol 14:1015- 1018, 1979
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
Jacobsen MB, Fausa O, Elgio K, Schrumpf E: Hepatic lesions in adult coeliac disease. Scand J Gastroenterol 25:656 - 662, 1990
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
Logan RFA, Ferguson A, Finlayson NDC, Weir DG: Primary biliary cirrhosis and coeliac disease: An association? Lancet 1:230 - 233, 1978
Iliffe GD, Owen DA: An association between primary biliary cirrhosis and jejunal villous atrophy resembling coeliac disease. Dig Dis Sci 24:802- 806, 1979
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
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
Bassendine MF, Dewar PJ, James OFW: HLA-DR antigens in primary biliary cirrhosis: Lack of association. Gut 26:625- 627, 1985
MacKay IR, Morris PJ: Association of autoimmune active chronic hepatitis with HLA-A1,-B8. Lance t 2:793- 795, 1972
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
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
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
Czaja AJ, Manns MP: The validity and importance of subtypes of autoimmune hepatitis: A point of view. Am J Gastroenterol 90:1206 - 1211, 1995
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
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
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
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
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
Terasaki PI, McClelland JD: Microdroplet assay for human serum cytotoxin. Nature 204:998 - 1000, 1964
Lindgren S, Sjoberg K, Erikson S: Unsuspected coe liac disease in chronic “Ccryptogenic” liver disease. Scand J Gastroente rol 29:661- 664, 1994
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
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
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
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
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
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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
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DOI: https://doi.org/10.1023/A:1026650118759