High levels of immunoglobulin A anti-tissue transglutaminase antibodies at diagnosis are a predictive factor for celiac hepatitis

Abstract

Introduction: Celiac hepatitis is characterized by the presence of liver injury in patients with celiac disease that resolves after gluten-free diet.Aim: To evaluate predictive factors of celiac hepatitis at celiac disease diagnosis.Methods: Retrospective study including 46 adult patients with the diagnosis of celiac disease.Results: Eighty-seven percent were women, with a mean age of 33 ± 11 years, 87% had a Marsh 3 and 46% (n = 21) had celiac hepatitis. These patients had a median Immunoglobulin A anti-tissue transglutaminase antibody (TTG-IgA) level of 208.0 U/ml (p25–p75: 89–1316 U/ml), a mean aspartate aminotransferase of 42 ± 24 U/L, alanine aminotransferase 50 ± 28 U/L, alkaline phosphatase 111 ± 64 U/L, at the time of diagnosis. Median TTG-IgA one year after diagnosis was 9U/ml (p25–p75: 4.5–30.5 U/ml) and 33% of the patients had normal values. At diagnosis, patients without celiac hepatitis had a median TTG-IgA of 77U/ml (p25–p75: 24–288 U/ml), mean aspartate aminotransferase of 23 ± 4 U/L, alanine aminotransferase 20 ± 6 U/L, alkaline phosphatase 69 ± 17 U/L. Median of TTG-IgA one year after diagnosis was 6 U/ml (p25–p75: 3–19 U/ml) and 48% had normal values. The celiac hepatitis group patients had higher values of TTG-IgA (p = 0.007) at diagnosis. There was a statistically significant positive correlation between TTG-IgA and alanine aminotransferase (r = 0.324, p = 0.028) at diagnosis. The odds of having celiac hepatitis was almost 5-fold higher in patients with a TTG-IgA level higher than 310 U/ml (OR = 4.8, 95%CI = 1.213–18.781, p = 0.025).Conclusions: Higher TTG-IgA levels are a predictive factor for celiac hepatitis in adult patients with celiac disease at diagnosis.