Celiac Disease More Than Twice As Common in Cirrhosis Patients

New study indicates routine screening may be warranted

Celiac disease is more than twice as common in people with cirrhosis of the liver than in the general population, a new study says —indicating that routine screening for celiac disease may be warranted for these patients.

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A group of researchers led by Jamile Wakim-Fleming, MD, a hepatologist at Cleveland Clinic, recently found that if doctors look for higher levels of certain antibodies that denote celiac disease, they can diagnose the digestive disease in patients with cirrhosis without having the patients undergo a small bowel biopsy to prove it.

The study, which was published online May 16 in Journal of Hepatology, is believed to be the largest prospective study to date to examine this topic.

Diagnosing celiac disease

Celiac disease is a digestive disease that damages the small intestine and interferes with the body’s ability to absorb nutrients from food.

People who have celiac disease cannot tolerate gluten, a protein in wheat, rye and barley. Long-term complications of celiac disease include liver diseases, cancers of the intestine and malnutrition, which can lead to anemia, osteoporosis and miscarriage, among other problems.

A medical history, physical exam and lab tests often point to celiac disease. But diagnosis is confirmed only with a biopsy of the small intestine, which is collected during endoscopy.

However, for patients with highly advanced cirrhosis, upper endoscopy and biopsies mean an increased risk for complications.

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Sufficient evidence

Dr. Wakim-Fleming says the study’s results suggest that blood tests that look for abnormally high levels of certain antibodies would be sufficient to diagnose celiac disease in patients with cirrhosis.

“This approach would be more cost-effective and help this medically fragile group of patients avoid the potential complications of undergoing a small bowel biopsy or endoscopy,” Dr. Wakim-Fleming says.

The research team studied 204 patients with cirrhosis who were undergoing an upper endoscopy to treat gastroesophageal varices, which are enlarged veins in the walls of the lower part of the esophagus.

The mean age of the patients was 55.4 years, and about half —46 percent —were women. Researchers followed the patients for two years.

The study participants all underwent small bowel biopsies and blood tests for celiac disease. The tests confirmed celiac disease in five people.

These five patients’ cirrhosis had origins other than celiac disease, which the study’s authors say indicates that celiac disease may coexist independently with other liver diseases.

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“These results lead us to conclude that all patients with cirrhosis should be screened for celiac disease regardless of whether they have primary biliary,, autoimmune hepatitis or another cause for their cirrhosis,” Dr. Wakim-Fleming says.

Gluten-free diet

The five patients with celiac disease were placed on a gluten-free diet, and researchers followed them for two years to see whether the new way of eating would have any effect on the patients’ cirrhosis.

One patient died before starting the gluten-free diet, but three of the remaining four showed improvement under a standard scoring system for assessment of the severity of chronic liver disease.

“Although the number of celiac disease patients in the study was too small to make any final conclusion on the outcome of cirrhosis with a gluten-free diet, the results were reassuring,” Dr. Wakim-Fleming says. “Blood tests for celiac disease in patients with cirrhosis are warranted because testing is easy and safe. Should the patient be found to have celiac disease, outcomes are favorable with a gluten-free diet.”

For more information, please contact Dr. Wakim-Fleming at 216.445.4871 or fleminj1@ccf.org