DI Biase AR, Colecchia A, Scaioli E, Berri R, Viola L, Vestito A, Balli F, Festi D
Systematic review: autoimmune liver diseases in a pediatric celiac population - a 10 year single-center experience. [JOURNAL ARTICLE]
Aliment Pharmacol Ther 2009 Oct 29.
Summary Backgroud Celiac disease (CD) can be associated with liver disease. Gluten-free diet (GFD) normalizes cryptogenic forms, but most likely not autoimmune hepatitis (AIH). For this condition immunosuppressants represent the treatment. However when these are stopped AIH generally relapeses To determine in CD children liver test abnormality frequency, the effect of GFD alone, or plus prolonged immunosuppressants, on AIH course. Methods CD patients with abnormal transaminases were selected; if transaminases < 5 x u.l.n., GFD alone was administered; if > 5 x u.l.n, liver examinations and biopsy were performed. In AIH immunosuppressants were administered (5 yrs). Treatment was stopped only if patients remained in remission during the entire maintenance period and normalized liver histology. Results 140 out of 350 CD children had hypertransaminaemia: 133 cryptogenic disease, 7 AIH. GFD normalized only cryptogenic hepatitis. During treatment, all AIH persistently normalized clinical and biochemical parameters; after withdrawal, 6 patients maintained a sustained remission (follow-up range: 12-63 months), while one relapsed. Conclusions In CD children with AIH, only GFD plus immunosuppressants determines a high remission rate. When clinical remission is reached, a prolonged immunosuppressive regimen induces a high sustained remission rate after treatment withdrawal, indicating that this regimen may prevent early relapse.
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