Celiac Disease and Its Impact on Liver-Related Outcomes in Patients With All-Cause Cirrhosis: The CELIHEP Study
Ankit Agarwal1, Aditya Vikram Pachisia2, Samagra Agarwal1
1Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India.
Insights
Screening for celiac disease (CeD) in cirrhosis patients is recommended. Early diagnosis and a gluten-free diet (GFD) may improve liver outcomes and prognosis in these individuals.
Area of Science:
- Hepatology
- Gastroenterology
- Autoimmune Diseases
Background:
- Celiac disease (CeD) is a multisystem autoimmune disorder.
- Cirrhosis, a severe liver condition, can coexist with CeD.
- Understanding this comorbidity is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of CeD in patients with cirrhosis.
- To evaluate the effect of a gluten-free diet (GFD) on liver outcomes in CeD patients with cirrhosis.
- To characterize patients with cirrhosis and positive celiac serology but without enteropathy.
Main Methods:
- 1959 cirrhosis patients were screened for CeD using IgA anti-tissue transglutaminase (anti-tTG) antibodies.
- Positive cases underwent further serological testing and duodenal biopsies.
- Definite CeD patients were matched (1:4) with non-CeD cirrhosis patients and followed for one year, with some receiving GFD.
Main Results:
- The prevalence of definite CeD was 1.8% (35/1959).
- Positive celiac serology without enteropathy was found in 7.2% (140/1959).
- One-year outcomes (liver decompensation, mortality) were similar between CeD patients on GFD and matched controls, but liver stiffness significantly decreased in the CeD group. Celiac serology normalized in CeD patients on GFD and in 72.1% of those with positive serology but no enteropathy without GFD.
Conclusions:
- Screening for CeD is recommended in all patients with cirrhosis, regardless of etiology.
- Early CeD diagnosis and adherence to a GFD can potentially improve prognosis and clinical outcomes in cirrhosis patients.
Background And Aims:
Celiac disease (CeD) is a multisystem disease and may coexist in patients with cirrhosis. We aimed to assess (1) CeD prevalence in all-cause cirrhosis, (2) the impact of a gluten-free diet (GFD) on liver-related outcomes in definite CeD, and (3) characteristics and follow-up of patients with positive celiac serology and cirrhosis without enteropathy.
Methods:
A total of 1959 consecutive patients with cirrhosis were screened for CeD using IgA anti-tissue transglutaminase antibody. All those having elevated anti-tTG Ab underwent anti-endomysial Ab testing and duodenal biopsies. Patients with definite CeD matched with those without CeD (1:4; CeD: no CeD matched for age, sex, baseline CTP, and MELD) were initiated on GFD plus standard of care (SOC) and SOC and followed up for 1 year.
Results:
Definite CeD was identified in 35 of 1959 (1.8%; 95% CI: 1.2%-2.4%) (n = 35; mean age: 37.3 ± 12.3; Child-Pugh Stage A/B/C: 17.1%/57.1%/25.7%; median MELD 19 [IQR: 17-22]), whereas the prevalence of positive celiac serology without enteropathy was 140 of 1959 (7.2%; 95% CI: 6.0%-8.3%). New-onset liver decompensations (34.3% vs. 44.3%) and mortality (17.1% vs. 13.6%) were similar in patients with CeD on GFD (n = 35) and the matched (n = 140) cohort without CeD over 1 year, but liver stiffness measurement decreased significantly in patients with CeD (28.5 ± 14.3 vs. 41.2 ± 18.31; p = 0.001). Patients with definite CeD showed normalization of celiac serology on GFD. One-year follow-up IgA tTG normalized in 88 of 122 (72.1%) patients with positive celiac serology without enteropathy without GFD.
Conclusion:
Patients with cirrhosis of the liver, irrespective of underlying etiology, should be screened for CeD. Early diagnosis of CeD and GFD may improve prognosis and clinical outcomes in patients with cirrhosis of the liver.
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