Liver involvement in pediatric celiac disease

Table 2 Studies reporting the prevalence of positive celiac serology or biopsy-proven celiac disease in children and adolescents with autoimmune liver diseases

Ref.	Study design	Study population with AILD	Number of patients with CD	Effect of GFD
Caprai et al[39], 2008	Retrospective	140 patients aged 7-125 mo with AILD	23 (16.4%) (19 with AIH; 2 with AIC; and 2 with overlap syndrome) had CD on the basis of serology (EMA IgA and/or tTGA IgA) Diagnosis of CD preceded the diagnosis of liver disease in 18 of the 23 patients	All patients achieved remission on GFD and immunosuppressive therapy, but 14 relapsed because of discontinuation of therapy or during spontaneous gluten challenge
Diamanti et al[40], 2008	Retrospective	40 patients aged 3-13.2 yr with AIH	5 (12.5%) had CD on the basis of serology and histological findings In four patients CD was diagnosed after AIH onset	On GFD four patients showed a mild decrease in transaminases, but never a complete normalization
Tosun et al[41], 2010	Retrospective	15 patients aged 4-15 yr with AIH	7 (46.0%) had CD on the basis of serology and histological findings CD and AIH were diagnosed concomitantly	Not available
El-Shabrawi et al[42], 2011	Prospective	26 patients aged 3.5-21 yr with AIH	CD serology (tTGA IgA and/or EMA IgA) was positive in 4 (15.4%). Three out of these four AIH (11.5%) showed histological findings of CD	Not available
Nastasio et al[43], 2013	Retrospective and Prospective	79 children and adolescents with AIH	15 (19.0%) had CD on the basis of serology and histological findings Diagnosis of CD preceded the diagnosis of liver disease in 8 of the 15 patients	All 15 patients on GFD achieved sustained remission when treated with immunosuppressive therapy

AILD: Autoimmune liver diseases; CD: Celiac disease; GFD: Gluten-free diet; AIH: Autoimmune hepatitis; EMA: Anti-endomysial antibodies; tTGA: Anti-tissue transglutaminase antibodies.