TY - JOUR T1 - Liver involvement in patients with coeliac disease: proof of causality using IgA/anti-TG2 colocalisation techniques JF - Journal of Clinical Pathology JO - J Clin Pathol SP - 766 LP - 773 DO - 10.1136/jclinpath-2020-206735 VL - 74 IS - 12 AU - Rimlee Dutta AU - Asif Iqbal AU - Prasenjit Das AU - Jayanth Kumar Palanichamy AU - Alka Singh AU - Wajiha Mehtab AU - Ashish Chauhan AU - Ashish Aggarwal AU - Vishnubhatla Sreenivas AU - Vineet Ahuja AU - Siddhartha Datta Gupta AU - Govind K Makharia Y1 - 2021/12/01 UR - http://jcp.bmj.com/content/74/12/766.abstract N2 - Aims Despite clinical evidence of liver involvement in patients with coeliac disease (CeD), there is a lack of a method to prove this association.Methods Of 146 treatment-naive patients with CeD, 26 had liver dysfunction. Liver biopsies and corresponding small intestinal biopsies were obtained from these 26 patients. Multicolour immunohistochemical and immunofluorescence confocal microscopic studies were performed on paraffin-embedded tissue to detect the IgA/anti-TG2 deposits. Follow-up liver biopsies were taken after a gluten-free diet.Results Twenty-six out of the 146 patients (17.8%) with suspected coeliac-associated liver disease on histological examination revealed irregular sinusoidal dilatation in 15 (57.6%), steatohepatitis in 4 (15.3%), non-specific chronic hepatitis in 3 (11.5%), autoimmune hepatitis in 2 (7.6%) biopsies, including cirrhosis in one of them, irregular perisinusoidal fibrosis and changes of non-cirrhotic portal fibrosis in one biopsy each (3.8%). IgA/anti-tTG deposits were observed in 22 (84.6%) liver biopsies by dual immunohistochemistry technique, and in 24 (92.3%) by confocal immunofluorescence technique and in all corresponding duodenal biopsies (100%). Overall, IgA/anti-tTG deposits showed 100% sensitivity, 77% specificity and 85% positive predictive value for establishing an association of extraintestinal pathology and CeD using archived tissues. Follow-up liver biopsies could be obtained in five patients; four of them showed not only resolution of the histological lesions but disappearance of IgA/anti-tTG co-localisation.Conclusions Data of the present study adds to the body of evidence that liver lesions in patients with CeD are disease related and may have been caused by a similar pathogenic mechanism that causes intestinal changes.Data are available on reasonable request. ER -