Celiac disease screening in patients with cryptogenic cirrhosis

We write a letter to the editor commenting the article“Who to screen and how to screen for celiac disease”.We discuss the present literature on cirrhosis and celiac disease(CD)and recommend screening and treating CD in individuals with cryptogenic cirrhosis.

Fatty liver and celiac disease:Why worry?

Celiac disease(CD)is a chronic inflammatory intestinal disorder mediated by the ingestion of gluten in genetically susceptible individuals.Liver involvement in CD has been widely described,and active screening for CD is recommended in patients with liver diseases,particularly in those with autoimmune disorders,fatty liver in the absence of metabolic syndrome,noncirrhotic intrahepatic portal hypertension,cryptogenic cirrhosis,and in the context of liver transplantation.Non-alcoholic fatty liver disease is estimated to affect approximately 25%of the world’s adult population and is the world’s leading cause of chronic liver disease.In view of both diseases’global significance,and to their correlation,this study reviews the available literature on fatty liver and CD and verifies particularities of the clinical setting.

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

Celiac disease(CD) is a systemic immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. The typical symptoms are anemia, diarrhea, fatigue, weight loss, and abdominal pain. CD has been reported in patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, aminotransferase elevations, nonalcoholic fatty liver disease, hepatitis B, hepatitis C, portal hypertension and liver cirrhosis. We evaluate recommendations for active screening for CD in patients with liver diseases, and the effect of a gluten-free diet in these different settings. Active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, steatosis in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. In hepatitis C, diagnosis of CD can be important as a relative contraindication to interferon use. Gluten-free diet ameliorates the symptoms associated with CD; however, the associated liver disease may improve, remain the same, or progress.

Elevated calprotectin levels are associated with mortality in patients with acute decompensation of liver cirrhosis

BACKGROUND Acute decompensation(AD)of cirrhosis is related to systemic inflammation and elevated circulating cytokines.In this context,biomarkers of inflammation,such as calprotectin,may be of prognostic value.AIM To evaluate serum calprotectin levels in patients hospitalized for complications of cirrhosis.METHODS This is a prospective cohort study that included 200 subjects hospitalized for complications of cirrhosis,20 outpatients with stable cirrhosis,and 20 healthy controls.Serum calprotectin was measured by enzyme-linked immunosorbant assay.RESULTS Calprotectin levels were higher among groups with cirrhosis when compared to healthy controls.Higher median calprotectin was related to Child-Pugh C,ascites,and hepatic encephalopathy.Higher calprotectin was related to acute-on-chronic liver failure(ACLF)and infection in the bivariate,but not in multivariate analysis.Calprotectin was not associated with survival among patients with ACLF;however,in patients with AD without ACLF,higher calprotectin was associated with a lower 30-d survival,even after adjustment for chronic liver failure-consortium(CLIF-C)AD score.A high-risk group(CLIF-C AD score≥60 and calprotectin≥580 ng/mL)was identified,which had a 30-d survival(27.3%)similar to that of patients with grade 3 ACLF(23.3%).CONCLUSION Serum calprotectin is associated with prognosis in patients with AD without ACLF and may be useful in clinical practice to early identify patients with a very low short-term survival.