Is celiac disease associated with cryptogenic chronic liver disease and non-cirrhotic intra-hepatic portal hypertension.

BACKGROUND AND AIMS: To study the spectrum of CD in patients with NCIPH /cryptogenic chronic liver disease (CLD) and to see the effects of gluten free diet in these patients. METHODS : Prospective case-control study looked at CD in cryptogenic CLD including NCIPH (cases) and hepatitis B/C related CLD (controls). IgA–TTG antibody (using recombinant human transglutaminase , ELISA (AESKULISA Celichek ) and anticardiolipin antibodies (IgG,IgA and IgM) (ELISA Varelisa kit) with titres at the time of diagnosis and duodenal biopsy with grading according to Marsh criteria was done.This was followed by subjecting the patients on gluten free diet and reassessing after minimum of 3 months. To study the association, bivariate analyses were done and the associations were studied using chi-square test (Fisher exact test). RESULTS : 60 cases (age 43 (10) years, (mean (SD)), males 46) and 59 controls (age 45 (11) years; males 53) were studied. Majority were from eastern India. Liver biopsy done in 20 cryptogenic CLD patients showed NCIPH (13) and cirrhosis (7). IgA TTG Ab was significantly positive in 40/58 cases (69%) with higher mean titres (70 U/ml) as compared to controls 16/59 (27%) (p = 0.00) mean titres (43 U/ml) (p 0.002). Marsh III, II/I and 0 were seen in 24%, 39% and 34% of cases and 0%, 32% and 68% of controls (p=0.002). Of 11 pts.with CD (mean age 43 yrs , 3 with silent disease) 5 of 7 who underwent liver biopsy had NCIPH. Follow up on GFD duration median 8 (3 – 14) months , TTG Antibody became negative in 5 patients and villous atrophy reversed in 3 patients. IgA anticardiolipin antibodies were not positive in any of the patients with CD. Gut permeability was increased in 4 of 8 (50%) pts of CD CONCLUSION: CD was seen in 24% pts. of cryptogenic cld which is much higher than reported prevalence in India. Of these 5 of 7 pts (71%) who underwent liver biopsy had NCIPH. NCIPH was recognised as the predominant cause of cryptogenic intrahepatic portal hypertension in our unit. Adult onset celiac disease was diagnosed in 10 patients.GI symptoms improved in all patients however an improvement in liver functions could not be determined probably because of the short follow up