Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

• Main Authors: Angelica Luciana Nau, Leonardo Fayad, Cesar Lazzarotto, Maria Beatriz Cacese Shiozawa, Esther Buzaglo Dantas-Correa, Leonardo de Lucca Schiavon, Janaina Luz Narciso-Schiavon
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2013-07-01
• Series: Revista da Sociedade Brasileira de Medicina Tropical
• Subjects: epatitis B virus; Hepatitis B; Celiac disease
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822013000400397&lng=en&tlng=en

Introduction Celiac disease is an autoimmune disorder that involves gluten intolerance and can be triggered by environmental factors including hepatitis B virus (HBV) infection. This study aimed to describe the prevalence of celiac disease in individuals with HBV infection and to describe the clinical and laboratory characteristics of celiac disease associated with HBV. Methods This cross-sectional study included 50 hepatitis B patients tested for IgA anti-endomysial antibodies (EMAs) and tissue anti-transglutaminase (TTG) between August 2011 and September 2012. Results Fifty patients were included with a mean age of 46.0 ± 12.6 (46.0) years; 46% were female and 13% were HBeAg+. Six patients had positive serology for celiac disease, four were EMA+, and five were TTG+. When individuals with positive serology for celiac disease were compared to those with negative serology, they demonstrated a higher prevalence of abdominal pain (100% vs. 33.3%, p = 0.008), lower median creatinine (0.7mg/dL vs. 0.9mg/dL, p = 0.007) and lower mean albumin (3.6 ± 0.4g/L vs. 3.9 ± 0.3g/L, p = 0.022). All individuals with positive serology for celiac disease underwent upper digestive endoscopy, and three of the patients exhibited a macroscopic pattern suggestive of celiac disease. Histologically, five patients demonstrated an intra-epithelial lymphocytic infiltrate level > 30%, and four patients showed villous atrophy associated with crypt hyperplasia on duodenal biopsy. Conclusions An increased prevalence of celiac disease was observed among hepatitis B patients. These patients were symptomatic and had significant laboratory abnormalities. These results indicate that active screening for celiac disease among HBV-infected adults is warranted.