Primer Biliyer Kolanjit ve Otoimmün Karaciğer Hastalıklarında Çölyak Hastalığı Prevalansı

Öz

Giriş: Çölyak hastalığı (ÇH),  glutene maruz kalındığında oluşan bir ince  bağırsak hastalığıdır. ÇH,  dermatitis herpetiformis, otoimmün tiroid hastalığı, tip 1 diabetes mellitus ve otoimmün karaciğer hastalıkları ile sıklıkla birliktelik  gösterir. Otoimmün hepatit (OİH) ve primer biliyer kolanjit (PBK) en sık görülen otoimmün karaciğer hastalıklarıdır. Bu çalışmada, hastanemizde PBK, OİH ve  PBK + OİH overlap tanılı  hastalarda  ÇH sıklığını araştırdık.

Metod: PBK, OİH ve  OİH + PBK overlap tanılı  hastalar çalışmaya dahil edilmiştir.ÇH tanısı spesifik serum antikorları ve spesifik duodenal biyopsi  bulguları ile konulmuştur.

Sonuçlar: PBK  (n = 47; F:% 95.7; yaş: 53 ± 10 yıl), OİH (n = 23; F:% 100; yaş: 48 ± 12 yıl) ve  OİH + PBK overlap (n = 29, F:% 96.6, yaş: 51 ± 10.9 yıl) tanılı  toplam  99 hasta çalışmaya dahil edilmiştir. PBC grubundaki üç (% 6.4),OİH grubunda 2 (% 8.7), PBK+OİH  overlap grubunda 1(% 3) hastaya serolojik ve histolojik bulgulara dayanarak ÇH tanısı  konuluştur.

Tartışma: Tek başına anti-gliadin antikoru (AGA) pozitifliği veya tek başına anti-endomisyum antikoru (EMA) pozitifliği ÇH  tanısı için yeterli değildir. Daha  kesin tanı  için,  ÇH  taramasında  her  2  testin  birlikte  kullanılmasını ve ÇH spesifik  antikorların  pozitif  tespit  edildiği olgularda, tanının duodenum  biyopsiyle  desteklenmesini öneriyoruz.  

Anahtar Kelimeler

• Çölyak hastalığı,primer biliyer kolanjit,otoimmün karaciğer hastalığı

Prevalence of Coeliac Disease in Autoimmune Liver Disease and Primary Biliary Cholangitis

Öz

Background: Coeliac disease (CD) is a small bowel disease, which occurs upon exposure to dietary gluten. CD is often associated with dermatitis herpetiformis, autoimmune thyroid disease, type 1 diabetes mellitus and autoimmune liver diseases. Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) are the most common autoimmune liver diseases. In this study, we investigated the prevalence of CD in patients with PBC, AIH and overlapping PBC + AIH  in our Hospital.

Methods: Ninety-nine patients with PBC, AIH and overlapping AIH + PBC were included in this study. Specific serum antibodies and specific duodenal biopsy results are  used  for  diagnosis  of  CD.

Results: Ninety-nine patients with PBC (n = 47; F: 95.7%; age: 53 ± 10 years), AIH (n = 23; F: 100%; age: 48 ± 12 years) and overlapping AIH + PBC (n = 29;F : 96.6%; age: 51 ± 10.9 years) were included in this study.Three patients (6.4%) in the PBC group, one patient (3%) in the PBC + AIH group and two patients (8.7%) in the AIH group were serologically and histologically diagnosed with CD.

Conclusion: Anti-gliadine antibody (AGA) positivity or anti-endomysium antibody (EMA) positivity alone was not sufficient for CD diagnosis. We suggest using both tests for CD screening to achieve more accurate results. In cases of positive CD-specific antibody results, we advise confirming the diagnosis by histopathological examination of duodenal biopsies.

Anahtar Kelimeler

• Coeliac disease,Autoimmune hepatitis,Primary biliary cholangitis

Kaynakça

1. 1. Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009;373:1480–93.
2. 2. Ciacci C, Cavallaro R, Iovino P, et al. Allergy prevalence in adult coeliac disease. J Allergy Clin Immunol 2004; 113:1199.
3. 3. Sorensen HT, Thulstrup AM, Blomqvist P, Norgaard B, Fonager K, Ekbom A. Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data. Gut 1999;44:736-8.
4. 4. Ludwig J, Dickson ER, McDonald GS. Staging of chronic nonsuppurative destructive cholangitis (syndrome ofprimary biliary cirrhosis). Virchows Arch A Pathol Anat Histol. 1978 Aug 22;379(2):103-12.
5. 5. Jones DE, Bhala N, Burt J, et al: Four year follow-up of fatigue in a geographically defined primary biliary cirrhosis cohort. Gut 2006; 55:536-41.
6. 6. Hennes EM1, Zeniya M, Czaja AJ, Parés A, Dalekos GN, Krawitt ELSimplified criteria for the diagnosis of autoimmune hepatitis. Hepatology. 2008 Jul;48(1):169-76.
7. 7. Ben-Ari Z, Czaja AJ: Autoimmune hepatitis and its variant syndromes. Gut 2001; 49:589-94
8. 8. Chazouilleres O, Wendum D, Serfaty L, et al: Primary biliary cirrhosis-autoimmune hepatitis overlap syndrome: Clinical features and response to therapy. Hepatology 1998; 28:296-301.

9. 9. Vivas S Ruiz de Morales JM, Fernandez M, Hernando M, Herrero B, Casqueiro J, Gutierrez S. Age-related clinical, serological, and histopathological features of coeliac disease. Am J Gastroenterol 2008; 103: 2360-2365;
10. 10. United European Gastroenterology. When is a coeliac a coeliac? Report of a working group of the United European Gastroenterology Week in Amsterdam, 2001. Eur J Gastroenterol Hepatol 2001;13:1123–8.
11. 11. Volta U, De Franceschi L, Lari F, et al. Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet 1998; 352:26.
12. 12. Bardella MT, Vecchi M, Conte D, et al. Chronic unexplained hypertransaminasemia may be caused by occult coeliac disease. Hepatology 1999; 29:654.
13. 13. Sainsbury A, Sanders DS, Ford AC. Meta-analysis: Coeliac disease and hypertransaminasaemia. Aliment Pharmacol Ther 2011; 34:33.
14. 14. Tatar G, Elsürer R, Şimşek H, et all. Screening of tissue transglutaminase antibody in healthy blood donors for coeliac disease screening in the Turkish population.Digestive Disease and Sciences,2004 Sep;49(9):1479-84.
15. 15. Elsurer R, Tatar G, Şimşek H, et all. Coeliac disease in the Turkish population. Digestive Disease and Sciences,Vol 50,No 1, Jan 2005; pp 136-140
16. 16. Mirzaagha F, Azali SH, Islami F, et al. Coeliac disease in autoimmune liver disease: a cross-sectional study and a systematic review. Dig Liver Dis 2010; 42:620.
17. 17. 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 1998; 43:2190.
18. 18. Villalta D, Girolami E, Alessio MG, et al. Autoantibody Profiling in a Cohort of Pediatric and Adult Patients With Autoimmune Hepatitis. J Clin Lab Anal 2016; 30:41.
19. 19. Van Gerven NM, Bakker SF, de Boer YS, et al. Seroprevalence of coeliac disease in patients with autoimmune hepatitis. Eur J Gastroenterol Hepatol 2014; 26:1104.
20. 20. Vajro P, Paolella G, Maggiore G, Giordano G. Pediatric coeliac disease, cryptogenic hypertransaminasemia, and autoimmune hepatitis. J Pediatr Gastroenterol Nutr 2013; 56:663.
21. 21. Nastasio S, Sciveres M, Riva S, et al. Coeliac disease-associated autoimmune hepatitis in childhood: long-term response to treatment. J Pediatr Gastroenterol Nutr 2013; 56:671
22. .22. Muratori P, Fabbri A, Lalanne C, Lenzi M, Muratori L.Autoimmune liver disease and concomitant extrahepatic autoimmune disease. Eur J Gastroenterol Hepatol. 2015 Oct;27(10):1175-9.
23. 23. Efe C, Wahlin S, Ozaslan E, Berlot AH, Purnak T, Muratori L, Quarneti C. Autoimmune hepatitis/primary biliary cirrhosis overlap syndrome and associatedextrahepatic autoimmune diseases. Eur J Gastroenterol Hepatol. 2012 May;24(5):531-4.
24. 24. Kingham JG, Parker DR. The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut. 1998;42:120-122.
25. 25. Bardella MT, Quatrini M, Zuin M, Podda M, Cesarini L, Velio P, Bianchi P, Conte D. Screening patients with coeliac disease for primary biliary cirrhosis and vice versa. Am J Gastroenterol. 1997;92:1524–1526.
26. 26. Dickey W, McMillan SA, Callender ME. High prevalence of coeliac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol. 1997;25:328–329.
27. 27. Ludvigsson JF, Elfström P, Broomé U, Ekbom A, Montgomery SM. Coeliac disease and risk of liver disease: a general population-based study. Clin Gastroenterol Hepatol. 2007 Jan;5(1):63-69.e1. Epub 2006 Dec 8.
28. 28. Abdo A, Meddings J, Swain M. Liver abnormalities in coeliac disease. Clin Gastroenterol Hepatol 2004; 2:107.
29. 29. Duggan JM, Duggan AE. Systematic review: the liver in coeliac disease. Aliment Pharmacol Ther 2005; 21:515.
30. 30. Kaukinen K, Halme L, Collin P, et al. Coeliac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure. Gastroenterology 2002; 122:881.