Anti tissue transglutaminase antibodies as predictors of silent coeliac disease in patients with hypertransaminasaemia of unknown origin

Background. Unexplained hypertransaminasaemia can be regarded as an extrain testinal presentation of coeliac disease. Aim, To evaluate the reliability of immunoglobulin A anti tissue transgluta minase antibodies for identifying coeliac disease in those patients. with r aised transaminases of unknown origin. Patients. Of 1120 consecutive patients referred to the outpatient clinic fo r, liver disease due to raised transaminases from September 1995 to Decembe r 1999, 110 were classified as having cryptogenic hypertransaminasaemia aft er the exclusion of every known cause of liver disease. Methods. These 110 patients were tested for immunoglobulin A anti tissue tr ansglutaminase and antiendomysial antibodies by enzyme-linked immunosorbent assay and indirect immunofluorescence, respectively. Results. Ten patients resulted positive fop both antibodies; in all of them duodenal biopsy showed a subtotal villous atrophy consistent with coeliac disease. They did not complain of any gastrointestinal symptom. Liver biops y, performed in five, showed a histological picture of non-specific reactiv e hepatitis. Conclusions. Due to the high proportion (9.1%) of patients with cryptogenic hypertransaminasaemia affected by symptomless coeliac disease, serological screening for gluten-sensitive enteropathy must be included in the work-up of these patients. In this respect, anti tissue transglutaminase antibodie s represent a valid alternative to antiendomysial antibodies with the advan tage of being feasible everywhere thanks to the worldwide availability of e nzyme-linked immunosorbent assay.