Searching for coeliac disease in patients with non-alcoholic fatty liver disease

M. T. Bardella, L. Valenti, C. Pagliari, M. Peracchi, M. Farè, A. L. Fracanzani, S. Fargion

Research output: Contribution to journalArticle

Abstract

Background. A non-negligible percentage of patients with non-alcoholic fatty liver disease, a leading cause of hepatic progressive disorder related to insulin resistance, have no metabolic risk factors, and abnormal intestinal permeability has been suggested to be involved in the pathogenesis of the liver damage. Coeliac disease, a curable disorder characterised by inflammatory mucosal damage, may show hepatic histological features similar to steatohepatitis. Conflicting data have been reported on the prevalence of coeliac disease in non-alcoholic steatohepatitis. Aim. To search for coeliac disease in a series of patients with non-alcoholic fatty liver disease by screening with anti-tissue transglutaminase and anti-endomysium antibodies. Patients and methods. Fifty-nine consecutive patients with hypertransaminasemia and non-alcoholic fatty liver disease, 38 (64%) with steatohepatitis. Anti-endomysium antibodies were assayed by indirect immunofluorescence, IgA anti-tissue transglutaminase by ELISA. Patients who tested positive underwent HLA DQ typing and endoscopy. Results. Tissue transglutaminase antibodies were positive in six (10%) patients and anti-endomysium in two (3.4%); only two (3.4%), positive for both anti-endomysium positive and anti-transglutaminase, resulted to have coeliac disease based on histological findings. After 6 months of gluten-free diet, liver enzymes normalised. Conclusions. The prevalence of silent coeliac disease is 3.4% in patients with non-alcoholic fatty liver. The inclusion of anti-endomysium antibodies test in studying patients with non-alcoholic fatty liver and persistent biochemical abnormalities has to be taken into account, since positivity for tissue transglutaminase antibodies, in the absence of confirmatory anti-endomysium antibodies, is not sufficient to perform diagnostic endoscopy.

Original languageEnglish
Pages (from-to)333-336
Number of pages4
JournalDigestive and Liver Disease
Volume36
Issue number5
DOIs
Publication statusPublished - May 2004

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Celiac Disease
Fatty Liver
Anti-Idiotypic Antibodies
Liver
Endoscopy
HLA-DQ Antigens
Gluten-Free Diet
Histocompatibility Testing
Transglutaminases
Non-alcoholic Fatty Liver Disease
Antibodies
Indirect Fluorescent Antibody Technique
Insulin Resistance
Permeability
Enzyme-Linked Immunosorbent Assay
transglutaminase 2
Enzymes

Keywords

  • Coeliac disease
  • Non-alcoholic fatty liver disease
  • Steatohepatitis
  • Transglutaminase

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Searching for coeliac disease in patients with non-alcoholic fatty liver disease. / Bardella, M. T.; Valenti, L.; Pagliari, C.; Peracchi, M.; Farè, M.; Fracanzani, A. L.; Fargion, S.

In: Digestive and Liver Disease, Vol. 36, No. 5, 05.2004, p. 333-336.

Research output: Contribution to journalArticle

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abstract = "Background. A non-negligible percentage of patients with non-alcoholic fatty liver disease, a leading cause of hepatic progressive disorder related to insulin resistance, have no metabolic risk factors, and abnormal intestinal permeability has been suggested to be involved in the pathogenesis of the liver damage. Coeliac disease, a curable disorder characterised by inflammatory mucosal damage, may show hepatic histological features similar to steatohepatitis. Conflicting data have been reported on the prevalence of coeliac disease in non-alcoholic steatohepatitis. Aim. To search for coeliac disease in a series of patients with non-alcoholic fatty liver disease by screening with anti-tissue transglutaminase and anti-endomysium antibodies. Patients and methods. Fifty-nine consecutive patients with hypertransaminasemia and non-alcoholic fatty liver disease, 38 (64{\%}) with steatohepatitis. Anti-endomysium antibodies were assayed by indirect immunofluorescence, IgA anti-tissue transglutaminase by ELISA. Patients who tested positive underwent HLA DQ typing and endoscopy. Results. Tissue transglutaminase antibodies were positive in six (10{\%}) patients and anti-endomysium in two (3.4{\%}); only two (3.4{\%}), positive for both anti-endomysium positive and anti-transglutaminase, resulted to have coeliac disease based on histological findings. After 6 months of gluten-free diet, liver enzymes normalised. Conclusions. The prevalence of silent coeliac disease is 3.4{\%} in patients with non-alcoholic fatty liver. The inclusion of anti-endomysium antibodies test in studying patients with non-alcoholic fatty liver and persistent biochemical abnormalities has to be taken into account, since positivity for tissue transglutaminase antibodies, in the absence of confirmatory anti-endomysium antibodies, is not sufficient to perform diagnostic endoscopy.",
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AU - Fracanzani, A. L.

AU - Fargion, S.

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AB - Background. A non-negligible percentage of patients with non-alcoholic fatty liver disease, a leading cause of hepatic progressive disorder related to insulin resistance, have no metabolic risk factors, and abnormal intestinal permeability has been suggested to be involved in the pathogenesis of the liver damage. Coeliac disease, a curable disorder characterised by inflammatory mucosal damage, may show hepatic histological features similar to steatohepatitis. Conflicting data have been reported on the prevalence of coeliac disease in non-alcoholic steatohepatitis. Aim. To search for coeliac disease in a series of patients with non-alcoholic fatty liver disease by screening with anti-tissue transglutaminase and anti-endomysium antibodies. Patients and methods. Fifty-nine consecutive patients with hypertransaminasemia and non-alcoholic fatty liver disease, 38 (64%) with steatohepatitis. Anti-endomysium antibodies were assayed by indirect immunofluorescence, IgA anti-tissue transglutaminase by ELISA. Patients who tested positive underwent HLA DQ typing and endoscopy. Results. Tissue transglutaminase antibodies were positive in six (10%) patients and anti-endomysium in two (3.4%); only two (3.4%), positive for both anti-endomysium positive and anti-transglutaminase, resulted to have coeliac disease based on histological findings. After 6 months of gluten-free diet, liver enzymes normalised. Conclusions. The prevalence of silent coeliac disease is 3.4% in patients with non-alcoholic fatty liver. The inclusion of anti-endomysium antibodies test in studying patients with non-alcoholic fatty liver and persistent biochemical abnormalities has to be taken into account, since positivity for tissue transglutaminase antibodies, in the absence of confirmatory anti-endomysium antibodies, is not sufficient to perform diagnostic endoscopy.

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KW - Transglutaminase

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