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Prevalence of celiac disease in patients with hepatitis B and C virus related cirrhosis and cryptogenic liver cirrhosis

Ayhan Balkan, Murat Taner Gulsen, Ramazan Erdem Er, Abdullah Emre Yildirim, Bugra Tolga Konduk, Sezgin Barutcu

Introduction: Celiac disease (CD) is a disease that involves many organs including the liver and is caused by autoimmune enteropathy. We aimed to compare the CD frequency between the cryptogenic cirrhosis and cirrhosis due to hepatitis B virus (HBV) and hepatitis C virus (HCV).

Materials and Methods: Patients with cryptogenic cirrhosis (n=83), HCV related cirrhosis (n=42) and HBV related cirrhosis patients (n=36) were enrolled to the study.

Results: Abnormal celiac serology was present in 24 (14.9%) of 161 cirrhotic patients. In 6 of them (3.7%) CD was diagnosed. Remaining 18 patients had false positive celiac serology and biopsy results were not compatible with CD. The incidence of abnormal celiac serology in patients with cryptogenic cirrhosis was significantly higher than that of patients with HBV and HCV related cirrhosis (P<0.004). CD was not detected in patients with HBV related cirrhosis. Among HCV-related cirrhosis patients, 3 patients (7%) were diagnosed with CD. In cryptogenic cirrhosis patients, 3 patients (3.6%) were diagnosed with CD. Anti-tissue transglutaminase (anti-tTG) and anti-endomysium (EMA) IgA values were abnormal in all of the 6 CD patients diagnosed. Marsh type 3 changes were detected in duodenal biopsies of these patients.

Conclusions: The prevalence of CD in cirrhosis patients was 3 times higher than in the normal population. However, contrary to expectations, the prevalence of CD in HCV-associated cirrhotic patients was 2-fold higher than in patients with cryptogenic cirrhosis. These results show that in cryptogenic cirrhosis cases, there is no significancy of CD in etiology, but the ratio of abnormal celiac serology is increased.