Celiac sprue: Another autoimmune syndrome associated with hepatitis C

OBJECTIVE: Celiac sprue is being diagnosed with increasing frequency by scr eening individuals with epidemiologically associated autoimmune syndromes. We sought to test our hypothesis that hepatitis C also may predispose to ce liac sprue because it can trigger autoimmune reactions. METHODS: Two hundred fifty-nine consecutively evaluated patients with chron ic hepatitis C infection, 59 with autoimmune liver disease, 137 with other hepatic diseases, 356 with various GI syndromes, and 221 normal volunteers underwent serologic screening for celiac sprue. Patients with antigliadin, antiendomysial, and antitissue transglutaminase antibodies in serum underwe nt duodenoscopy and biopsy. RESULTS: There was a statistically significantly higher prevalence of antig liadin antibody in all groups of patients with liver disease compared with GI controls and normal controls. However, only patients with hepatitis C (n = 3; 1.2%) or autoimmune liver disease (n = 2; 3.4%) had antiendomysial/an titissue transglutaminase antibody in serum. One of 221 normal volunteers ( 0.4%) was antigliadin, antiendomysial, and antitissue transglutaminase posi tive; this individual also was found to have hepatitis C (previously undiag nosed). Each of these six individuals had mild intestinal symptoms, duodena l histopathology consistent with celiac sprue, and the celiac-associated HL A-DQ2 allele. Five of the six followed a prescribed gluten-free diet and ex perienced symptomatic improvement. CONCLUSION: Celiac sprue is epidemiologically associated with chronic hepat itis C infection and with autoimmune liver disease. Because hepatitis C is much more frequently encountered than autoimmune liver disease, hepatitis C appears to be the most common hepatic disease associated with the developm ent of celiac sprue. (Am J Gastroenterol 2001;96:138-145. (C) 2001 by Am. C ell. of Gastroenterology).