Araştırma Makalesi
Yıl 2019,
Cilt: 58 Sayı: 3, 246 - 250, 20.09.2019
Öz
Aim: Autoimmune disorders tend to show co-occurrence.
Coeliac disease (CD) may accompany primary biliary
cirrhosis (PBC) like other autoimmune
diseases. In this study, we aimed to evaluate the prevalance of CD in PBC
patients.
Materials and
Methods: Two
hundred and thirty-eight patients whom
diagnosed as PBC between April 2006-December 2017 and 205 healthy volunteers as
control group compared prospectively. AGA IgG, AGA IgA, EMA IgG and EMA IgA
results evaluated. Duodenum biopsies were obtained in patients who had positive
AGA an EMA results.
Results: Median age was 54.2+12 in PBC patients and 43.8+14.4 in control group. Sixteen
of 238 PBC patients and 90 of 205 control were male. Four (1.7%) PBC patients
had AGA and EMA positivity. None of PBC patients had symptoms for CD. Thirteen
(5.46%) patients had AGA positivity with low titration. One (0.4%) healthy
control had EMA and AGA positivity and there was no statistical difference
between two groups (p=0.379). According to Marsh classification of duodenal
biopsies we found one Marsh 1, one Marsh 2 and two Marsh 3 in PBS group. one
control who had positive EMA and AGA results showed Marsh 3 in duodenal
biopsies
Conclusion: PBC and CD may be associated. PBC patients who are seropositive for CD
must be followed according to complications of CD. Gluten-free diet is required
for these patients.
Anahtar Kelimeler
Kaynakça
- Poupon R, Chazouilleres O, Balkau B, Poupon RE. Clinical and biochemical expression of the histopathological lesions of primary biliary cirrhosis. UDCA-PBC group. J Hepatol 1999; 30 (3): 408-12.
- Culp KS, Fleming CR, Duffy J, et al. Autoimmune associations in primary biliary cirrhosis. Mayo Clin Proc 1982; 57 (6): 365-70.
- Angulo P, Lindor KD. Primary biliary cirrhosis and primary sclerosing cholangitis. Clin Liver Dis 1999; 3 (3): 529-70.
- Amil Dias J. Celiac disease: What do we know in 2017? GE Port J Gastroenterol 2017;24 (6): 275-8.
- Troncone R, Auricchio S, De Vincenzi M, Donatiello A, Farris E, Silano V. An analysis of cereals that react with serum antibodies in patients with coeliac disease. J Pediatr Gastroenterol Nutr 1987; 6 (3): 346-50.
- Sategna Guidetti C, Solerio E, Scaglione N, Aimo G, Mengozzi G. Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders. Gut 2001; 49 (4): 502-5.
- Iltanen S, Collin P, Korpela M, et al. Celiac disease and markers of celiac disease latency in patients with primary Sjogren’s syndrome. Am J Gastroenterol 1999; 94 (4): 1042-6.
- Lahteenoja H, Toivanen A, Viander M, et al. Oral mucosal changes in coeliac patients on a gluten-free diet. Eur J Oral Sci 1998; 106 (5): 899-906.
- Aine L. Permanent tooth dental enamel defects leading to the diagnosis of coeliac disease. Br Dent J 1994; 177 (7): 253-4.
- Salem SN, Truelove SC. Small intestinal and gastric abnormalities in ulcerative colitis. Br Med J 1965;1 (5438): 827-31.
- Tursi A, Giorgetti GM, Brandimarte G, Elisei W. High prevalence of celiac disease among patients affected by Crohn’s disease. Inflamm Bowel Dis 2005; 11 (7): 662-6.
- Kaila B, Orr K, Bernstein CN. The anti-Saccharomyces cerevisiae antibody assay in a province-wide practice: Accurate in identifying cases of Crohn’s disease and predicting inflammatory disease. Can J Gastroenterol 2005; 19 (12): 717-21.
- Farre C, Esteve M, Curcoy A, et al. Hypertransaminasemia in pediatric celiac disease patients and its prevalence as a diagnostic clue. Am J Gastroenterol 2002; 97 (12): 3176-81.
- Dickey W, McMillan SA. Co-screening for primary biliary cirrhosisand coeliac disease. Association between primary biliary cirrhosis and coeliac disease. Gut 1998; 43 (2): 300.
- Volta U, De Franceschi L, Molinaro N, et al. Frequency and significance of anti-gliadin and anti-endomysial antibodies in autoimmune hepatitis. Dig Dis Sci 1998; 43 (10): 2190-5.
- Sedlack RE, Smyrk TC, Czaja AJ, Talwalkar JA. Celiac disease associated autoimmune cholangitis. Am J Gastroenterol 2002; 97 (12): 3196-8.
- West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 2003; 52 (7): 960-5.
- Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: A large multicenter study. Arch Intern Med 2003; 163 (3): 286-92.
- Kingham JGC, Parker DR. The association between primary biliary cirrhosis and coeliac disease: A study of relative prevalences. Gut 1998; 42 (1): 120-2.
- Bardella MT, Quatrini M, Zuin M, et al. Screening patients with celiac disease for primary biliary cirrhosis and vice versa. Am J Gastroenterol 1997; 92 (9): 1524-6.
- Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology 2001; 120 (3): 636-51.
- Demirçeken FG. Gluten enteropatisi (çölyak hastalığı): Klasik bir öykü ve güncel gelişmeler. Güncel Gastroenteroloji 2011; 15 (1): 58-72.
- Brannagan TH 3rd, Hays AP, Chin SS, et al. Small-fiber neuropathy/neuronopathy associated with celiac disease: Skin biopsy findings. Arch Neurol 2005; 62 (10): 1574-8.
- Rampertab SD, Forde KA, Green PH. Small bowel neoplasia in coeliac disease. Gut 2003; 52 (8): 1211-4.
- Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D. Prevalence of hypertransaminasaemia in adult celiac patients and effect of gluten-free diet. Hepatology 1995; 22 (3): 833-6.
- Dickey W, McMillan SA, Collins JS, Watson RG, McLoughlin JC, Love AH. Liver abnormalities associated with celiac sprue. How common are they, what is their significance and what do we do about them? J Clin Gastroenterol 1995; 20 (4): 290-2.
- Novacek G, Miehsler W, Wrba F, Ferenci P, Penner E, Vogelsang H. Prealence and clinical importance of hypertransaminaseaemia in coeliac disease. Eur J Gastroenterol Hepatol 1999; 11 (3): 283-8.
- Leonardi S, Bottaro G, Patane R, Musumeci S. Hypertransaminaseaemia as the first symptom in infant celiac disesae. J Paediatr Gastroenterol Nutr 1990; 11 (3): 404-6.
- Altuntas B, Kansu A, Girgin N. Hepatic damage in gluten sensitive enteropathy. Acta Paediatr Jap 1998; 40 (6): 597-9.
- Volta U, De Franceschi L, Lari F, Molinaro N, Zoli M, Bianchi FB. Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet 1998; 352 (9121): 26-9.
- Bardella MT, Vecchi M, Conte D, et al. Chronic unexplained hypertransaminasaemia may be caused by occult celiac disease. Hepatology 1999; 29 (3): 654-7.
- Behr W, Barnert J. Adult celiac disease and primuary biliary cirrhosis. Am JGastroenterol 1986; 81 (9): 796-9.
- Falchuk ZM. Gluten-sensitive enteropathy. Clin Gastroenterol 1983; 12 (2): 475-94.
- Sherlock S. Primary biliary cirrhosis: Critical evaluation and treatment policies. Scand J Gastroenterol (suppl) 1982; 77 (1): 63-74.
- Korponay-Szabo IR, Halttunen T, Szalai Z, et al. In vivo targeting of intestinal and extraintestinal transglutaminase 2 by celiac autoantibodies. Gut 2004; 53 (5): 641-8.
- Floreani A, Chiaramonte M, Venturini R, et al. Antigliadin antibody classes in chronic liver diseases. Ital J Gastroenterol 1992; 24 (8): 457-60.
- Sjoberg K, Lindgren S, Eriksson S. Frequent occurrence of non-specific gliadin antibodies in chronic liver disease. Endomysial but not gliadin antibodies predict coeliac disease in patients with chronic liver disease. Scand J Gastroenterol 1997; 32 (11): 1162-7.
- Dickey W, McMillan SA, Callender ME. High prevalence of celiac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol 1997;25(1):328-9.
- Volta U, Caigo G, Tovoli F, De Giorgio R. Gut-liver axis: An immune link between celiac disease and primary biliary cirrhosis. Expert Rev Gastroenterol Hepatol 2013;7(3):253-61.
- Narciso-Schiavon JL, Schiavon LL. To screen or not to screen? Celiac antibodies in liver diseases. World J Gastroenterol 2017; 23 (5): 776-91.
- Muratori P, Fabbri A, Lalanne C, Lenzi M, Muratori L. Autoimmune liver disease and concomitant extrahepatic autoimmune disease. Eur J Gastroenterol Hepatol 2015; 27 (10): 1175-9.
- Floreani A, Franceschet I, Cazzagon N, et al. Extrahepatic autoimmune conditions associated with primary biliary cirrhosis. Clin Rev Allergy Immunol 2015; 48 (2-3): 192-7.
- Teufel A, Weinmann A, Kahaly GJ, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol 2010;44(3): 208-13.
Yıl 2019,
Cilt: 58 Sayı: 3, 246 - 250, 20.09.2019
Öz
Amaç: Otoimmun hastalıklar genel olarak birliktelik gösterme eğilimindedirler.
Primer biliyer siroza (PBS) da diğer otoimmun hastalıkların yanı sıra çölyak
hastalığı (ÇH) eşlik edebilmektedir. Bu çalışmada PBS’li hastalarda ÇH’nin prevalansı
değerlendirildi.
Gereç ve Yöntem: Çalışmada Nisan 2006-Aralık 2017 tarihleri arasında tanı alan ve takipli
olan 238 PBS’li hasta, kontrol grubu olarak alınan 205 sağlıklı gönüllü ile
prospektif olarak karşılaştırıldı. Hastalarda Anti Gliadin IgA ve IgG (AGA),
Anti Endomisyum IgA ve IgG (EMA) antikorları immunofloresans yöntemi ile
bakıldı. Antikorları pozitif saptanan hastalardan duodenum ikinci kısmından
biyopsi alındı.
Bulgular:
Çalışmaya alınan 238 hastanın yaş
ortalaması 54,2±12 olup 16’sı erkekti.
Kontrol grubundaki 205 kişinin 115’i kadın (%56,1), 90’ı erkek ve yaş
ortalaması 43,8±14,4’tü. PBS’li 4 hastada
AGA ve EMA pozitifliği (%1,7) saptandı. PBS’li hastaların hiçbirinde ÇH semptomları
yoktu. On üç (%5,46) hastada ise düşük titrede AGA pozitifliği saptandı.
Kontrol grubundaki bir (%0,4) hastada EMA, AGA IgA ve IgG yüksek titrede
pozitif saptandı ve PBS’li grup ile istatistiksel fark saptanmadı (p=0,379).
PBS tanısı olan ve EMA, AGA pozitif saptanan dört
hastanın biyopsisinde, bir hastada Marsh 1, bir hastada Marsh 2 ve iki hastada
Marsh 3 ile uyumlu duodenum biyopsi bulguları saptandı. EMA ve AGA’sı pozitif
olan kontrol grubundaki bir hastanın ince barsak biyopsisi ise Marsh 3 ile
uyumluydu.
Sonuç: PBS ve ÇH, birbiri ile ilişkili olabilen hastalıklardır. PBS tanılı
hastalarda, ÇH açısından seropozitif olan hastaların takibinin ÇH ve
komplikasyonlarına de yönelik olması ve tanı konulan hastalara glutensiz
diyetin başlanması gerekmektedir.
Anahtar Kelimeler
Kaynakça
- Poupon R, Chazouilleres O, Balkau B, Poupon RE. Clinical and biochemical expression of the histopathological lesions of primary biliary cirrhosis. UDCA-PBC group. J Hepatol 1999; 30 (3): 408-12.
- Culp KS, Fleming CR, Duffy J, et al. Autoimmune associations in primary biliary cirrhosis. Mayo Clin Proc 1982; 57 (6): 365-70.
- Angulo P, Lindor KD. Primary biliary cirrhosis and primary sclerosing cholangitis. Clin Liver Dis 1999; 3 (3): 529-70.
- Amil Dias J. Celiac disease: What do we know in 2017? GE Port J Gastroenterol 2017;24 (6): 275-8.
- Troncone R, Auricchio S, De Vincenzi M, Donatiello A, Farris E, Silano V. An analysis of cereals that react with serum antibodies in patients with coeliac disease. J Pediatr Gastroenterol Nutr 1987; 6 (3): 346-50.
- Sategna Guidetti C, Solerio E, Scaglione N, Aimo G, Mengozzi G. Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders. Gut 2001; 49 (4): 502-5.
- Iltanen S, Collin P, Korpela M, et al. Celiac disease and markers of celiac disease latency in patients with primary Sjogren’s syndrome. Am J Gastroenterol 1999; 94 (4): 1042-6.
- Lahteenoja H, Toivanen A, Viander M, et al. Oral mucosal changes in coeliac patients on a gluten-free diet. Eur J Oral Sci 1998; 106 (5): 899-906.
- Aine L. Permanent tooth dental enamel defects leading to the diagnosis of coeliac disease. Br Dent J 1994; 177 (7): 253-4.
- Salem SN, Truelove SC. Small intestinal and gastric abnormalities in ulcerative colitis. Br Med J 1965;1 (5438): 827-31.
- Tursi A, Giorgetti GM, Brandimarte G, Elisei W. High prevalence of celiac disease among patients affected by Crohn’s disease. Inflamm Bowel Dis 2005; 11 (7): 662-6.
- Kaila B, Orr K, Bernstein CN. The anti-Saccharomyces cerevisiae antibody assay in a province-wide practice: Accurate in identifying cases of Crohn’s disease and predicting inflammatory disease. Can J Gastroenterol 2005; 19 (12): 717-21.
- Farre C, Esteve M, Curcoy A, et al. Hypertransaminasemia in pediatric celiac disease patients and its prevalence as a diagnostic clue. Am J Gastroenterol 2002; 97 (12): 3176-81.
- Dickey W, McMillan SA. Co-screening for primary biliary cirrhosisand coeliac disease. Association between primary biliary cirrhosis and coeliac disease. Gut 1998; 43 (2): 300.
- Volta U, De Franceschi L, Molinaro N, et al. Frequency and significance of anti-gliadin and anti-endomysial antibodies in autoimmune hepatitis. Dig Dis Sci 1998; 43 (10): 2190-5.
- Sedlack RE, Smyrk TC, Czaja AJ, Talwalkar JA. Celiac disease associated autoimmune cholangitis. Am J Gastroenterol 2002; 97 (12): 3196-8.
- West J, Logan RF, Hill PG, et al. Seroprevalence, correlates, and characteristics of undetected coeliac disease in England. Gut 2003; 52 (7): 960-5.
- Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: A large multicenter study. Arch Intern Med 2003; 163 (3): 286-92.
- Kingham JGC, Parker DR. The association between primary biliary cirrhosis and coeliac disease: A study of relative prevalences. Gut 1998; 42 (1): 120-2.
- Bardella MT, Quatrini M, Zuin M, et al. Screening patients with celiac disease for primary biliary cirrhosis and vice versa. Am J Gastroenterol 1997; 92 (9): 1524-6.
- Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology 2001; 120 (3): 636-51.
- Demirçeken FG. Gluten enteropatisi (çölyak hastalığı): Klasik bir öykü ve güncel gelişmeler. Güncel Gastroenteroloji 2011; 15 (1): 58-72.
- Brannagan TH 3rd, Hays AP, Chin SS, et al. Small-fiber neuropathy/neuronopathy associated with celiac disease: Skin biopsy findings. Arch Neurol 2005; 62 (10): 1574-8.
- Rampertab SD, Forde KA, Green PH. Small bowel neoplasia in coeliac disease. Gut 2003; 52 (8): 1211-4.
- Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D. Prevalence of hypertransaminasaemia in adult celiac patients and effect of gluten-free diet. Hepatology 1995; 22 (3): 833-6.
- Dickey W, McMillan SA, Collins JS, Watson RG, McLoughlin JC, Love AH. Liver abnormalities associated with celiac sprue. How common are they, what is their significance and what do we do about them? J Clin Gastroenterol 1995; 20 (4): 290-2.
- Novacek G, Miehsler W, Wrba F, Ferenci P, Penner E, Vogelsang H. Prealence and clinical importance of hypertransaminaseaemia in coeliac disease. Eur J Gastroenterol Hepatol 1999; 11 (3): 283-8.
- Leonardi S, Bottaro G, Patane R, Musumeci S. Hypertransaminaseaemia as the first symptom in infant celiac disesae. J Paediatr Gastroenterol Nutr 1990; 11 (3): 404-6.
- Altuntas B, Kansu A, Girgin N. Hepatic damage in gluten sensitive enteropathy. Acta Paediatr Jap 1998; 40 (6): 597-9.
- Volta U, De Franceschi L, Lari F, Molinaro N, Zoli M, Bianchi FB. Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet 1998; 352 (9121): 26-9.
- Bardella MT, Vecchi M, Conte D, et al. Chronic unexplained hypertransaminasaemia may be caused by occult celiac disease. Hepatology 1999; 29 (3): 654-7.
- Behr W, Barnert J. Adult celiac disease and primuary biliary cirrhosis. Am JGastroenterol 1986; 81 (9): 796-9.
- Falchuk ZM. Gluten-sensitive enteropathy. Clin Gastroenterol 1983; 12 (2): 475-94.
- Sherlock S. Primary biliary cirrhosis: Critical evaluation and treatment policies. Scand J Gastroenterol (suppl) 1982; 77 (1): 63-74.
- Korponay-Szabo IR, Halttunen T, Szalai Z, et al. In vivo targeting of intestinal and extraintestinal transglutaminase 2 by celiac autoantibodies. Gut 2004; 53 (5): 641-8.
- Floreani A, Chiaramonte M, Venturini R, et al. Antigliadin antibody classes in chronic liver diseases. Ital J Gastroenterol 1992; 24 (8): 457-60.
- Sjoberg K, Lindgren S, Eriksson S. Frequent occurrence of non-specific gliadin antibodies in chronic liver disease. Endomysial but not gliadin antibodies predict coeliac disease in patients with chronic liver disease. Scand J Gastroenterol 1997; 32 (11): 1162-7.
- Dickey W, McMillan SA, Callender ME. High prevalence of celiac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol 1997;25(1):328-9.
- Volta U, Caigo G, Tovoli F, De Giorgio R. Gut-liver axis: An immune link between celiac disease and primary biliary cirrhosis. Expert Rev Gastroenterol Hepatol 2013;7(3):253-61.
- Narciso-Schiavon JL, Schiavon LL. To screen or not to screen? Celiac antibodies in liver diseases. World J Gastroenterol 2017; 23 (5): 776-91.
- Muratori P, Fabbri A, Lalanne C, Lenzi M, Muratori L. Autoimmune liver disease and concomitant extrahepatic autoimmune disease. Eur J Gastroenterol Hepatol 2015; 27 (10): 1175-9.
- Floreani A, Franceschet I, Cazzagon N, et al. Extrahepatic autoimmune conditions associated with primary biliary cirrhosis. Clin Rev Allergy Immunol 2015; 48 (2-3): 192-7.
- Teufel A, Weinmann A, Kahaly GJ, et al. Concurrent autoimmune diseases in patients with autoimmune hepatitis. J Clin Gastroenterol 2010;44(3): 208-13.
Toplam 43 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 28 Şubat 2018 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 58 Sayı: 3 |
