High Rates of Celiac Disease in Autoimmune Hepatitis Patients

Celiac.com 01/03/2022 - Studies looking at rates of celiac disease in people with autoimmune hepatitis (AIH) have shown wide ranging results.  A team of researchers recently set out to examine the rates of celiac disease in individuals with autoimmune hepatitis.

For their systematic review and meta-analysis the team used two professional librarians to conduct a search of PubMed, EMBASE, Cochrane and Web of Science Core Collection up to 7 February 2020.  Search terms included 'celiac disease', 'celiac', 'transglutaminases', 'gluten', 'gliadin', 'EMA', 'TTG' and 'villous' combined with 'autoimmune', 'hepatitis', 'ANA', 'SMA' and 'LKM'. 

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This search yielded 2,419 unique publications. A systematic review based on the PRISMA guidelines resulted in 31 articles eligible for full text review. They found fifteen relevant articles, eight of which they included in their main analysis. The team used a fixed-effect inverse variance-weighted model, and calculated heterogeneity.

The team's main analysis included 567 autoimmune hepatitis patients from eight studies. Twenty three of those patients showed biopsy-verified celiac disease equivalent to Marsh III. The pooled rate of celiac disease in autoimmune hepatitis patients 3.5%, which is more than triple the 1% celiac disease rates in most general populations. 

When also including the fifteen studies on 1,817 people where celiac disease had been diagnosed through positive serology without biopsy, the pooled rate of celiac disease was just under 3%.

The team's results show high rates of celiac disease in people with autoimmune hepatitis compared to the general population. As such, they are recommending that physicians consider celiac disease screening for patients with autoimmune hepatitis.

Read more in Liver International. 2021;44(11):2693-2702. 

The research team included Linnea Haggård; Ida Glimberg; Benjamin Lebwohl; Rajani Sharma; Elizabeth C. Verna; Peter H. R. Green; and Jonas F. Ludvigsson. They are variously affiliated with the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the School of Medical Sciences, Örebro University, Örebro, Sweden; the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; the Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY, USA; the Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; and the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.