RT Journal Article
SR Electronic
T1 Liver involvement in patients with coeliac disease: proof of causality using IgA/anti-TG2 colocalisation techniques
JF Journal of Clinical Pathology
JO J Clin Pathol
FD BMJ Publishing Group Ltd and Association of Clinical Pathologists
SP 766
OP 773
DO 10.1136/jclinpath-2020-206735
VO 74
IS 12
A1 Dutta, Rimlee
A1 Iqbal, Asif
A1 Das, Prasenjit
A1 Palanichamy, Jayanth Kumar
A1 Singh, Alka
A1 Mehtab, Wajiha
A1 Chauhan, Ashish
A1 Aggarwal, Ashish
A1 Sreenivas, Vishnubhatla
A1 Ahuja, Vineet
A1 Datta Gupta, Siddhartha
A1 Makharia, Govind K
YR 2021
UL http://jcp.bmj.com/content/74/12/766.abstract
AB Aims Despite clinical evidence of liver involvement in patients with coeliac disease (CeD), there is a lack of a method to prove this association.Methods Of 146 treatment-naive patients with CeD, 26 had liver dysfunction. Liver biopsies and corresponding small intestinal biopsies were obtained from these 26 patients. Multicolour immunohistochemical and immunofluorescence confocal microscopic studies were performed on paraffin-embedded tissue to detect the IgA/anti-TG2 deposits. Follow-up liver biopsies were taken after a gluten-free diet.Results Twenty-six out of the 146 patients (17.8%) with suspected coeliac-associated liver disease on histological examination revealed irregular sinusoidal dilatation in 15 (57.6%), steatohepatitis in 4 (15.3%), non-specific chronic hepatitis in 3 (11.5%), autoimmune hepatitis in 2 (7.6%) biopsies, including cirrhosis in one of them, irregular perisinusoidal fibrosis and changes of non-cirrhotic portal fibrosis in one biopsy each (3.8%). IgA/anti-tTG deposits were observed in 22 (84.6%) liver biopsies by dual immunohistochemistry technique, and in 24 (92.3%) by confocal immunofluorescence technique and in all corresponding duodenal biopsies (100%). Overall, IgA/anti-tTG deposits showed 100% sensitivity, 77% specificity and 85% positive predictive value for establishing an association of extraintestinal pathology and CeD using archived tissues. Follow-up liver biopsies could be obtained in five patients; four of them showed not only resolution of the histological lesions but disappearance of IgA/anti-tTG co-localisation.Conclusions Data of the present study adds to the body of evidence that liver lesions in patients with CeD are disease related and may have been caused by a similar pathogenic mechanism that causes intestinal changes.Data are available on reasonable request.