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  • Clinicopathological and immunological characteristics and outcome of concomitant coeliac disease and non-alcoholic fatty liver disease in adults: a large prospective longitudinal study

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Coeliac disease
Clinicopathological and immunological characteristics and outcome of concomitant coeliac disease and non-alcoholic fatty liver disease in adults: a large prospective longitudinal study
  1. Sanaa Kamal1,2,
  2. Khaled K Aldossari3,
  3. Dhalia Ghoraba1,
  4. Sara Mahmoud Abdelhakam1,
  5. Amgad H Kamal1,
  6. Mohamad Bedewi4,
  7. Leila Nabegh5,
  8. Khaled Bahnasy6,
  9. Tamer Hafez7
  1. 1 Department of Gastroenterology and Tropical Medicine, Ain Shams University Faculty of Medicine, Cairo, Egypt
  2. 2 Department of Medicine, PSAU, Cairo, Egypt
  3. 3 Department of Family Medicine, Prince Sattam Bin Abdul Aziz College of Medicine, Al-Kharj, Riyadh, Saudi Arabia
  4. 4 Department of Radiodiagnosis, Prince Sattam Bin Abdul Aziz College of Medicine, Kharj, Riyadh, Saudi Arabia
  5. 5 Department of Pathology, Ain Shams Faculty of Medicine, Cairo, Egypt
  6. 6 Department of Bioinformatics, Faculty of Computer Science, Ain Shams University, Cairo, Egypt
  7. 7 Department of Immunology and Molecular Biology, American University, Cairo, Egypt
  1. Correspondence to Dr Sanaa Kamal; sanaakamal{at}ainshamsmedicine.net

Abstract

Objective Concomitant non-alcoholic fatty liver disease (NAFLD) and coeliac disease (CD) have not been adequately studied. This study investigated the frequency of CD among NAFLD patients and the clinicopathological and immunological patterns and outcome of concomitant NAFLD and CD.

Design This prospective longitudinal study screened patients with NAFLD for CD (tissue transglutaminase antibodies (TTGA); anti-TTGA and antiendomysial antibodies (EMA)). Patients with concomitant NAFLD and CD and patients with either NAFLD or CD were enrolled and followed. Duodenal biopsy, transient elastography, tumour necrosis factor (TNF)-alpha, transforming growth factor-beta, interleukins (ILs) 1, 6, 10, 15 and 17, folic acid and vitamins B12 and D were performed at baseline and 1 year after gluten-free diet (GFD).

Results CD was confirmed in 7.2% of patients with NAFLD. Refractory anaemia and nutritional deficiencies were frequent in patients with concomitant NAFLD and CD who had advanced intestinal and hepatic lesions, higher levels of TNF-α, IL-15 and IL-17 compared with patients with CD and NAFLD. Patients concomittant CD and NAFLD showed clinical response to GFD, but intestinal histological improvement was suboptimal. Combining EMA-IgA or anti-TTGA with either IL-15 or IL-17 enhances the prognostic performance of both tests in predicting histological response to GFD.

Conclusion Concomitant NAFLD and CD is not uncommon. Recurrent abdominal symptoms, refractory anaemia, nutritional deficiencies in patients with NAFLD warrant screening for CD. The study has important clinical implications since failure in diagnosing CD in patients with NAFLD patients results in marked intestinal and hepatic damage and suboptimal response to GFD that can be alleviated by early diagnosis and initiation of GFD.

  • celiac disease
  • nonalcoholic steatohepatitis
  • cytokines
  • gluten free diet
  • small intestinal biopsy

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjgast-2017-000150

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    Footnotes

    • Contributors All authors contributed in clinical work, patient enrolment, data collection, data entry and writing of the manuscript.

    • Funding This study is funded by Prince Sattam bin Abdulaziz University (grant no: PSAU291625), Ain Shams University (grant no: R-2094-2011), Science & Technology Development Fund (STDF) (grant no: STDF/384/2011-2015).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Ain Shams University.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional anonymous unpublished data from the study are available. The data may be accessed by the investigators.