To screen or not to screen? Celiac antibodies in liver diseases

Table 4 Case reports regarding the association of autoimmune hepatitis and celiac disease

Number of patients	Symptoms	AIH antibodies	Celiac antibodies	Duodenal biopsy	Response to gluten-free diet	Liver biopsy	Comorbidities	Country, year	Authors
1	Anemia, infection	ASM 1:500	AGA IgA and IgG (+)	Typical1	Yes2	Active chronic hepatitis	Erythroblastopenia	France, 2001	Bridoux-Henno et al[124]
		anti-vimentin 1:500	EmA (+)
1	Weight loss,	ANA 1:1280, p-ANCA 1:2560, SMA 1:1200, LKM1 1:50	Reticulin antibodies	Typical1	No, developed AIH despite of a gluten-free diet	Chronic inflammation	Thyrotoxicosis	Finland, 2002	Arvola et al[34]
	fatigue, abdominal pain, and diarrhea		to 1:2000			In the portal area and proliferation of the small hepatic
			AGA IgA (+)			Ductules. Patchy degeneration of the liver cells.
2	Diarrhea, abdominal enlargement and	ANA (+)	?	?	case 1: poor response to a	Acute hepatitis	-	Italy, 2003	Leonardi et al[125]
	failure to thrive.	SMA (+)			gluten-free diet for the treatment of hepatitis;	With portal bridging necrosis and fibrosis and a
		antiactine (+)			case 2: developed AIH despite the diet	Peri-portal inflammatory infiltrate of lymphocytes,
						Plasma cells and neutrophils
1	Elevated liver enzymes detected, hypesthesia of the left	ANA (+)	AGA (+)	Typical1	Poor adherence to diet	Moderately active, chronic hepatitis with	Cryoglobulinaemia	Switzerland, 2003	Biecker et al[126]
	foot, purpura and skin ulcers of both legs.		EmA (+)			Interface lesions and fibrosis of the portal tract,
						Bile duct lesions and ductular
						Proliferations.
1	Jaundice and pale stools.	All negative. Score probable	AGA IgA (+)	Typical1	Liver disease progressed despite the diet	Moderate to severe	.-	Italy, 2004	Iorio et al[127]
			AGA IgG (+)			lobular inflammatory activity, mononuclear portal
			Ema (+)			inflammation, interface hepatitis, and portal and periportal
			tTG IgA (+)			fibrosis with septae; rosetting of liver cells
						and some giant cells.
1	Ferropenia	-	tTG (+)	Villous atrophy	Elevation of aminotranferases despite the diet.	severe ymphocytic inflammatory infiltrate		Peru, 2006	Tagle et al[128]
	and elevation of aminotransferases.					with slight increase of collagen in
						portal tracts, foci of lobular necrosis and presence
						acidophilus bodies
1	Anorexia, severe diarrhea, rapid loss of weight,	ANA (+)	EmA (+)	Villous atrophy	Developed cirrhosis despite the diet	Cirrhosis	Holmes-Adie syndrome	Hungary, 2006	Csak et al[129]
	amenorrhea and anemia.	SMA (+)	tTG (+)
1	Jaundice	SMA (+)	AGA (+)	Typical1	Poor adherence to diet	Confirmed the diagnosis of acute AIH	Multiple sclerosis	Italy, 2008	Ferrò et al[130]
			EmA (+)
			tTG IgA (+) IgG (+)
1	Weight loss, anorexia, fatigue, and diarrhea.	ANA+++	AGA IgA (+)	Typical1	Liver disease was diagnosed on a gluten-free diet	Moderately active, chronic hepatitis with interface lesions	Autoimmune cholangitis overlap, Autoimmune thyroiditis	Turkey, 2009	Ozaslan et al[131]
			AGA IgG (+)			And fibrosis of the portal tracts, ductular injury and ductopenia.
			EmA (+)
			tTG (+)
1	Malaise,	ANA, SMA, LKM-1, mitochondrial, anti-LC1,	EmA (+)	Typical1	No, developed AIH despite of a gluten-free diet	Lymphoplasmacytic hepatitis (portal interface and lobular)	-	United Kingdom, 2009	Quail et al[132]
	intermittent pyrexia and vomiting, an urticarial-vasculitic	anti-SLA/LP, parietal cell	tTG (+)			With moderate to marked activity and minimal
	rash and joint pains.	antibodies, all negative				Chronicity (fibrosis stage 1/6).
1	Two miscarriages, iron deficiency anemia, osteopenia and alternating bowel habit, elevated aminotransferases	ANA +++, homogeneous; SMA ++, anti-dsDNA	EmA 1:160	Severe villous atrophy	Yes2	Chronic	Lupus	Italy, 2010	Tovoli et al[133]
		0.1527778				Active hepatitis with piecemeal necrosis and lympho-plasmacellular periportal infiltrate
1	anemia, weakness and high	ANA 1:640,	EmA (+)	Flat mucosa	No, developed acute liver failure	Severe fibrosis	None	Italy, 2013	Volta et al[134]
	aminotransferase levels	SMA 1:320,	tTG (+)
		pANCA 1:160
1	Miscontrol of diabetes	ANA 1:160	IgA tTG (+)	Typical1	Yes2	Moderate interface hepatitis and chronic inflammatory infiltrate, and foci of necrosis	Autoimmune thyroiditis and type 1 diabetes	Spain, 2016	Dieli-crimi et al[135]
	Altered liver enzymes		EmA (-)

¹Vilous atrophy, crypt hyperplasia, lymphoplasmocytic infiltrate;

²Patient under corticosteroids and azathioprine. AGA: Anti-gliadin antibody; EmA: Anti-endomysial antibody; tTG: Anti-tissue transglutaminase antibody; ANA: Anti-nuclear antibody; ASM: Anti-smooth muscle antibodies; anti-LP: Antibodies against liver pancreas; anti-SLA: Antibodies against soluble liver antigen.