Prevalence of Celiac Disease in Patients With Primary Biliary Cholangitis: A Systematic Review and Meta-Analysis

Celiac disease (CeD) has been linked to both autoimmunity and chronic liver disease, but most data on the link to primary biliary cholangitis (PBC) originate from small studies and have yielded conflicting results. A systematic search was performed in the databases of Medline, Embase, Cochrane and Web of Science Core Collection for studies published between 1990 and 2024, using search terms related to CeD, gluten and PBC. The search identified 2016 publications, of which 94 were read in full text. Of these, a total of 25 studies were included in this review, with 22 deemed relevant for meta-analysis. We applied a random effects model to estimate the weighted pooled prevalence along with corresponding 95% confidence intervals (CIs). Results were reported in accordance with the PRISMA guidelines. Our main analysis contained 15 006 individuals with PBC from 22 studies. Among these, 286 (1.9%; 286/15174) had a CeD diagnosis yielding a pooled prevalence of 1.71% (95% CI: 1.08-2.44). When restricting the analysis to 15 studies with biopsy-confirmed CeD, the pooled prevalence was 1.53% (95% CI: 0.51-2.91). This prevalence is comparable to the serology-based prevalence of CeD, of around 1%, in the general population. Our findings suggest that the prevalence of CeD in PBC is similar to that observed in the general population. These findings do not support routine screening for CeD in individuals with PBC.