FREQUENT OCCURRENCE OF NONSPECIFIC GLIADIN ANTIBODIES IN CHRONIC LIVER-DISEASE - ENDOMYSIAL BUT NOT GLIADIN ANTIBODIES PREDICT CELIAC-DISEASE IN PATIENTS WITH CHRONIC LIVER-DISEASE

Background: The frequency of gliadin antibody (GA) positivity has been found to be increased among patients with chronic liver disease, as h as that of coeliac disease (CD). CD has also been found to be increase d among patients with primary biliary cirrhosis (PBC) or primary scler osing cholangitis (PSC). Methods: To investigate these relationships f urther, a micro-enzyme-linked immunosorbent assay and immunofluorescen ce tests for GAs and endomysial antibodies (EMAs) were performed in la rge subgroups of patients representing various chronic liver diseases and in healthy blood donors. Results: As compared with blood donors (a mong whom it was 5%) the frequency of IgA GA positivity was higher in all patient subgroups: alcoholic liver disease, 20% (22 of 110, P < 0. 001); PBC, 16% (16 of 101, P < 0.001); PSC, 24% (19 of 80, P < 0.001); chronic hepatitis, 19% (13 of 70, P < 0.001); and hepatitis C virus i nfection, 11% (11 of 104, P < 0.01). Two patients with autoimmune chro nic hepatitis were EMA-positive, and in both cases the presence of CD was verified by small-bowel biopsy. Conclusions: IgA GA positivity gen erally occurs at increased frequency among patients with chronic liver disease and may represent nonspecific immune activation. In liver dis ease GA testing is not useful in screening for CD, whereas the EMA tes t seems to be highly specific. CD is more prevalent than expected amon g patients with autoimmune chronic hepatitis but not among those with PBC or PSC.