Celiac disease in pediatric patients with autoimmune hepatitis: etiology, diagnosis, and management.

摘要: Celiac disease (CD) is defined as a permanent intolerance to ingested wheat gliadins and other cereal prolamins, occurring in genetically susceptible people. Persistent elevation of serum aminotransferase activity expression liver damage related CD, which occurs two distinctive forms. The most frequent mild asymptomatic injury, with moderate increase activities inflammatory portal lobular infiltrate on biopsy (celiac hepatitis), reversible gluten-free diet (GFD). More rarely, severe progressive damage, induced by an autoimmune process identified hepatitis (AIH), can develop it generally unaffected gluten withdrawal. Surveys that included only pediatric patients report wide range prevalence CD AIH 11.5–46% (mean 21.5%). share selected combinations genes coding for class II human leukocyte antigens, could explain their coexistence. Increased intestinal permeability circulation anti-tissue transglutaminase (tTG) have also been considered further potential causes patients. tTG the extraintestinal tissues modify external- or self-antigens generate different neo-antigens, are responsible injury CD. Patients represent population at high risk developing CD; screening should be integrated into diagnostic routine all AIH, without gastrointestinal manifestations, before starting immunosuppressive treatments. currently available treatment GFD supportive nutritional care iron, calcium, vitamin deficiencies. Due difficulties GFD, past decade researchers become increasingly interested therapeutic alternatives continuous intermittent use Interventions addressed correct defect barrier advanced stage clinical trials. impact outcome not clear but seems ineffective AIH. early detection however, may prevent progression end-stage failure.