Journal of gastroenterology and hepatology · 2025
Celiac Disease and Its Impact on Liver-Related Outcomes in Patients With All-Cause Cirrhosis: The CELIHEP Study.
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Agarwal Ankit, Pachisia Aditya Vikram, Agarwal Samagra, Mehta Shubham, Kumari Alka, Ahmed Anam, Sharma Sonu, Kumar Sambuddha, Mehra Lalita, Das Prasenjit, Shalimar, Ahuja Vineet, Makharia Govind K
Аннотация
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.
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.