Clinical Analysis Of Autoimmune Liver Disease In Patients With Celiac Disease

Background Celiac disease(CD)also refers to gluten-sensitive enteropathy,nontropical sprue or celiac sprue.It is a chronic autoimmune disease,precipitated by the ingestion of gluten-containing foods,which affects the small intestine in genetically predisposed children and adults.In addition to intestinal mucosal lesions,CD is also a multiple-organ autoimmune disease,such as type 1 diabetes mellitus(T1DM),autoimmune thyroiditis and autoimmune liver disease(AILD).For the past few years,several studies associated with the incidence of AILD in patients with CD have been reported,mostly approved that AILD is a risk factor of CD.However,reports about the characteristics of cases in the complication are few at home and abroad.In order to enhance the understanding and improve the level of diagnosis and treatment of the disease,all data of 10 patients diagnosed as CD with AILD,including clinical characteristics and biochemistry indexes,markers of inflammation,autoantibodies,HLA-DQ2 and HLA-DQ8,liver and intestinal mucosa histology,complications and therapy were analyzed.To enhance the comprehension of CD with AILD and improve the level of the diagnosis and treatment of CD with AILD.ObjectiveMethods 756 patients with chronic diarrhea were studied in this research,who came to the first Affiliated Hospital of Zhengzhou University from September 2015 to September 2016,among whom 44 patients were diagnosed as CD and 10 patients with CD as AILD simultaneously.Liver speciments from 10 cases of CD with AILD were studied by routine stain and immunohistochemistry,intestinal mucosa speciments from 44 cases of CD were studied by routine stain.All data of 44 patients,including clinical manifestation,the results of biochemistry and inflammation,autoantibodies,HLA-DQ2 and HLA-DQ8,serum specific Ig G antibody on 14 foods intolerance,bone mineral density,treatment programme and prognosis were analyzed.The gluten-free diet(GFD)combined with the standardized treatment programme of different types of AILD were given to these patients.Clinical efficacy and survival rate were evaluated.Results 1.The morbidity of CD in patients with chronic diarrhea was 5.82%.In all cases of celiac disease,the morbidity of CD with AIH was 4.55%,CD with PBC was 9.10%,CD with AIH-PBC overlap syndrome was 9.10%.2.Clinical manifestations,baseline biochemical data,specific antibodies titer of CD and genotypes in two groups were comparable(P>0.05),including abdominal distension,fatigue,anorexia,stomachache,AGA-Ig A,t TGA-Ig A,DGP-Ig A,DGP-Ig G,HLA-DQ2 and HLA-DQ8.There are statistical significance in these two groups(P<0.05),such as Ig G,globulin and jaundice.3.Most of CD patients were simultaneously diagnosed with other diseases.(mainly other autoimmune diseases,osteopenia or andosteoporosis and food intolerance).4.In CD with AILD group,after the treatment for at least 6 months,3 of the 10 patients' s hepatic fibrosis degree reduced.As for the prognosis,statistical differences were observed between CD group and CD with AILD group(P<0.05).Conclusion 1.The morbidity of CD in patients with chronic diarrhea was significantly higher than the general population.As for chronic diarrhea patients,it is necessary to consider the diagnosis of CD.2.As a result of diversity of clinical situation,when CD patients were found Ig G and globulin increased and jaundice,it is necessary to consider CD is complicated with AILD.3.In CD with AILD group,GFD may be helpful to reduce hepatic fibrosis degree,but it needs more investigations,and it is necessary to screen AILD in patients with chronic liver damage in CD.