Liver and Bile
Eur J Gastroenterol Hepatol. 2023;35(9):1030–6
Prevalence of autoimmune, cholestatic and non-alcoholic fatty liver disease in celiac disease
Background: While there is higher prevalence of autoimmune, cholestatic and fatty liver disease in celiac disease, most data is from small-scale studies. The authors evaluated the prevalence and risk factors of the same using large cohort data.
Methods: A population-based cross-sectional study was conducted using Explorys, a multi-institutional database. Prevalence and risk factors of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and non-alcoholic fatty liver disease (NAFLD) in celiac disease were assessed.
Results: Out of 70,352,325 subjects, 136,735 had celiac disease (0.19%). The prevalence of AIH (0.32%), PBC (0.15%), PSC (0.004%) and NAFLD (0.7%) were high in celiac disease. After adjusting for age, gender, Caucasian race and anti-tissue transglutaminase antibody (anti-TTG), celiac disease subjects had higher odds of AIH (adjusted odds ratio [aOR] = 7.06, 95% confidence interval [CI]: 6.32–7.89) and PBC (aOR = 4.16, 95% CI: 3.46–5.0). Even after adjusting for celiac disease, anti-TTG positivity concurred with higher odds of AIH (aOR = 4.79, 95% CI: 3.88–5.92) and PBC (aOR = 9.22, 95% CI: 7.03–12.1). After adjusting for age, gender, Caucasian race, diabetes mellitus (DM), obesity, hypothyroidism and metabolic syndrome, there was higher prevalence of NAFLD in celiac disease, with the aOR in the presence of DM type 1 being 2.1 (95% CI: 1.96–2.25), and in the presence of DM type 2 being 2.92 (95% CI: 2.72–3.14).
Conclusion: Subjects with celiac disease are more likely to have autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis and non-alcoholic fatty liver disease (NAFLD). AIH and PBC have higher odds in the presence of anti-tissue transglutaminase antibody. The odds of NAFLD in celiac disease are high regardless of type of diabetes mellitus.