Seroprevalence of celiac disease in patients with autoimmune hepatitis

Prevalence data of celiac disease (CD) in patients with autoimmune hepatitis (AIH) are scarce. We investigated the relationship between AIH and CD by assessing the prevalence of IgA tissue antitransglutaminase antibodies (TGA) and antiendomysium antibodies (EMA) in a large cohort of AIH patients.

The frequency of CD was determined by TGA antibody serology in a cohort of 460 AIH patients. In case of TGA positivity, patients were further tested for EMA serology. Retrospective data on previously diagnosed CD and patient characteristics were retrieved from computerized or written medical records. Findings were compared with archival data on the prevalence of CD in the Netherlands (n=1440).

Six patients had a known history of CD and were currently in remission as determined by negative TGA serology. In addition, 10 of the 460 AIH patients (2.2%) had positive IgA TGA. Diagnosis of CD was further substantiated by positive EMA antibodies in these patients. Combined, CD was found in 3.5% of AIH patients compared with 0.35% in the general Dutch population (P<0.001). When excluding patients with either a primary biliary cirrhosis or primary sclerosing cholangitis overlap, in 11 (2.8%) AIH patients, CD was found.

This is the largest serological study on the association between AIH and CD and demonstrates that the presence of CD in AIH patients is more common compared with the general population; yet, it is not as high as described in some previous small studies. The possibility of concurrent CD should be considered in all AIH patients.