Primer Biliyer Kolanjit ve Otoimmün Karaciğer Hastalıklarında Çölyak Hastalığı Prevalansı

Year 2018, Volume: 8 Issue: 4, 295 - 298, 31.12.2018

Genco Gencdal , Cenk Emre Meral Elif Azarsız Güzide Aksu , Fulya Günşar , Ulus Salih Akarca

https://doi.org/10.16899/gopctd.468748

Abstract

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.  

Keywords

Çölyak hastalığı, primer biliyer kolanjit, otoimmün karaciğer hastalığı

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

Abstract

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.

Keywords

Coeliac disease, Autoimmune hepatitis, Primary biliary cholangitis

References

• 1. Di Sabatino A, Corazza GR. Coeliac disease. Lancet 2009;373:1480–93.
• 2. Ciacci C, Cavallaro R, Iovino P, et al. Allergy prevalence in adult coeliac disease. J Allergy Clin Immunol 2004; 113:1199.
• 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. 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. 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. 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. Ben-Ari Z, Czaja AJ: Autoimmune hepatitis and its variant syndromes. Gut 2001; 49:589-94
• 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. 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. 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. Volta U, De Franceschi L, Lari F, et al. Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet 1998; 352:26.
• 12. Bardella MT, Vecchi M, Conte D, et al. Chronic unexplained hypertransaminasemia may be caused by occult coeliac disease. Hepatology 1999; 29:654.
• 13. Sainsbury A, Sanders DS, Ford AC. Meta-analysis: Coeliac disease and hypertransaminasaemia. Aliment Pharmacol Ther 2011; 34:33.
• 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. 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. 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. 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. 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. 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. Vajro P, Paolella G, Maggiore G, Giordano G. Pediatric coeliac disease, cryptogenic hypertransaminasemia, and autoimmune hepatitis. J Pediatr Gastroenterol Nutr 2013; 56:663.
• 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. 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. 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. Kingham JG, Parker DR. The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut. 1998;42:120-122.
• 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. 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. 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. Abdo A, Meddings J, Swain M. Liver abnormalities in coeliac disease. Clin Gastroenterol Hepatol 2004; 2:107.
• 29. Duggan JM, Duggan AE. Systematic review: the liver in coeliac disease. Aliment Pharmacol Ther 2005; 21:515.
• 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.