Gluten-free diet improves celiac disease associated with cryptogenic cirrhosis, suggests study
Researchers have discovered that patients who also have biopsy-proven celiac disease (CeD) with cryptogenic cirrhosis benefit significantly by the treatment with a gluten-free diet (GFD). A recent study was conducted by Pachisia and colleagues which was published in The American Journal of Gastroenterology.
Celiac disease frequently involves the liver, and as many as 4.6% of patients with cryptogenic cirrhosis are likely to have undiagnosed CeD. The aim of this study was to determine the prevalence of CeD in patients with cryptogenic cirrhosis and compare liver-related outcomes of these patients after a gluten-free diet (GFD) compared with a propensity-score-matched cohort of patients without CeD on standard care (SOC).
This multicenter study screened 232 consecutive patients with cryptogenic cirrhosis for CeD using IgA anti-tissue transglutaminase antibody (anti-tTG), anti-endomysial antibody (AEA), and duodenal and liver biopsies. Biopsy samples underwent IgA/anti-tTG colocalization studies for definitive diagnosis.
Patients diagnosed with CeD and matched controls without CeD (1:4 ratio, matched by age, sex, Child-Turcotte-Pugh [CTP] score, and MELD score) were treated with GFD plus SOC or SOC alone, respectively. Liver-related outcomes, including MELD and CTP scores, decompensation events, and mortality, were assessed over a one-year follow-up.
Key Findings
Prevalence of CeD in Cryptogenic Cirrhosis :
• Among 232 patients, 14 had elevated anti-tTG antibody levels (16.9±10.5-fold rise), 9 were AEA positive, and 11 (4.7%) were biopsy-proven for CeD.
Baseline Characteristics:
Patients with CeD (n=11) and matched controls (n=44) showed similar baseline demographics and liver disease severity:
• Age: 31.3±7.7 (CeD) vs. 31.8±9.3 years (non-CeD).
• Females: 45.5% (CeD) vs. 34.1% (non-CeD).
• MELD score: Median 9 (IQR: 8–15.5) vs. 12 (9–15).
• CTP score: Median 7 (IQR: 6–7.5) vs. 6 (5.75–7).
Liver Outcomes with GFD:
• Patients with CeD on GFD showed significant improvements in liver scores compared with patients without CeD.
• Follow-up MELD score: Median 9 (IQR: 7.5–10.5) vs. 18.5 (12–20) (p=0.001).
• Follow-up CTP score: Median 5 (IQR: 5–5) vs. 8 (7–9) (p<0.001).
• The number of decompensation events was smaller, and the mortality was not significantly different between CeD patients and non-CeD controls.
• Decompensations: Less frequent in CeD group; no numbers were reported.
• Mortality: 9.1% (CeD) vs. 18.2% (non-CeD) (p=0.67).
Liver-related outcomes improved significantly with GFD among these patients, which signifies the importance of early diagnosis and dietary intervention in this population.
Reference:
Pachisia, A. V., Agarwal, A., Mehta, S., Kumari, A., Dwarakanathan, V., Sharma, S., Kumar, S., Mehra, L., Dutta, R., Das, P., Agrawal, S., Shalimar, Ahuja, V., & Makharia, G. K. (2024). Celiac disease is common in adults with cryptogenic cirrhosis and responds favourably to gluten-free diet. The American Journal of Gastroenterology, 10.14309/ajg.0000000000003244.https://doi.org/10.14309/ajg.0000000000003244
