Prevalence and clinical relevance of enteropathy associated with systemic autoimmune diseases

• Published in: Digestive and liver disease Vol. 44; no. 8; pp. 636 - 642
• Main Authors: Vives, Maria-José, Esteve, Maria, Mariné, Meritxell, Fernández-Bañares, Fernando, Alsina, Montserrat, Salas, Antonio, Loras, Carme, Carrasco, Anna, Almagro, Pere, Viver, Josep Mª, Rodriguez-Carballeira, Mónica
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-08-2012
• Subjects: Adult; Atrophy - complications; Autoimmune diseases; Autoimmune Diseases - blood; Autoimmune Diseases - complications; Autoimmune Diseases - genetics; Celiac Disease - blood; Celiac Disease - complications; Celiac Disease - genetics; Celiac Disease - pathology; Chi-Square Distribution; Coeliac disease; Connective Tissue Diseases - immunology; Diagnosis and aetiology of enteropathy; Diet, Gluten-Free; Duodenum - pathology; Enteropathy; Female; Gastroenterology and Hepatology; Genotype; Helicobacter Infections - complications; Helicobacter pylori; HLA-DQ Antigens - blood; HLA-DQ Antigens - genetics; Humans; Lymphocytes; Male; Middle Aged; Systemic Vasculitis - immunology; Enteropathy; Autoimmune diseases; Coeliac disease; Diagnosis and aetiology of enteropathy
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2012.02.013

Abstract Objective To assess whether systemic autoimmune diseases are a risk group for coeliac disease and if there is a systemic autoimmune diseases-associated enteropathy. Methods 183 patients with systemic autoimmune diseases were included. Duodenal biopsy was carried out on patients with positive coeliac genetics (HLA-DQ2-DQ8) and/or serology and/or symptoms of the coeliac disease spectrum. When enteropathy was found, causes, including gluten sensitivity, were investigated and categorized according to a sequentially applied treatment. Results were analysed with Chi-square or Fisher exact tests. Results The prevalence of coeliac disease with atrophy was 0.55% (1 of 183 patients). Thirty-eight of the 109 patients (34.8%) who underwent duodenal biopsy had lymphocytic enteropathy (8 infectious, 5 due to gluten sensitive enteropathy, 5 HLA-DQ2/DQ8 who did not accept gluten-free diet and 20 of unknown aetiology). Lymphocytic enteropathy was unrelated to disease activity or immunosuppressants. HLA-DQ2 was more frequent in connective tissue disease (41.5%) compared with systemic vasculitis and autoinflammatory diseases (17.9%) ( p = 0.02), whereas a lower percentage of lymphocytic enteropathy was observed in the former (20.2% vs. 41.6%). Lymphocytic enteropathy was clinically irrelevant in cases with no definite aetiology. Discussion One third of systemic autoimmune diseases patients had enteropathy of uncertain clinical meaning in the majority of cases, which was rarely due to gluten sensitive enteropathy.