Prevalence of Celiac Disease in Autoimmune Liver Diseases

Abstract

Background: Celiac disease (CD) is more prevalent in autoimmune liver diseases (AILDs) than in the general population. Screening for CD is recommended in patients with AILDs. Objectives: This study aimed to determine the prevalence of CD among patients with AILDs in a tertiary hepatology outpatient clinic and to evaluate the clinical features of patients with concurrent CD. Materials and Methods: A total of 94 patients with AILDs were identified in the institutional database during the study period. Among these, 89 patients had available anti-tissue transglutaminase IgA (anti-tTG IgA) measurements and were included in the analysis. Of these, 40 had autoimmune hepatitis (AIH), 37 had primary biliary cholangitis (PBC), and 12 had AIH-PBC overlap. Anti-tTG IgA positivity together with Marsh type 3 histology was accepted as diagnostic. Results: Anti-tTG IgA positivity was found in 12.5% (5/40) of AIH patients. At the time of testing, 82.5% of patients were receiving immunosuppressive therapy. CD prevalence was 7.5% (3/40) in AIH, 2.7% (1/37) in PBC, and 8.3% (1/12) in AIH-PBC overlap. Regarding liver disease status, two of three AIH patients with CD were in remission. Both the PBC patient and the AIH-PBC overlap patient with CD were also in remission. Sjögren syndrome was the most common extrahepatic autoimmune disease, particularly in PBC, where 43.2% of patients had at least one extrahepatic autoimmune disease. Conclusion: This study demonstrates an increased prevalence of CD in AILDs, particularly in AIH. The findings support incorporating CD screening into the initial evaluation of AILDs. Early recognition is important before starting immunosuppressive therapy, which may obscure serological and histological features, thereby delaying diagnosis and treatment.