P0918 - An Investigation of Celiac Disease Severity in Patients Presenting with Elevated Liver Enzymes

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Award: Presidential Poster Award

Presenting Author(s)

Christopher Cao, MD

Thomas Jefferson University Hospital
Philadelphia, PA, United States

Award: Presidential Poster Award

Christopher Cao, MD¹, Ritu Nahar, MD¹, Sahaj Mujumdar, MD¹, Nicholas Noverati, MD¹, Angela Heysel, BS¹, Zachary Breslin, BS¹, Robin Miller, ARNP¹, Michael Matthews, ¹, Emily Rubin, RD¹, Dina Halegoua-DeMarzio, MD², Jonathan M. Fenkel, MD¹, Stephanie Moleski, MD¹, Anthony J. DiMarino, MD¹
¹Thomas Jefferson University Hospital, Philadelphia, PA; ²Thomas Jefferson University, Philadelphia, PA

Introduction: Celiac disease (CD) is well known to affect the liver. An association between CD and liver damage was first described in 1977 when it was noted that 40% of adults with CD had increased transaminases. Since then, further studies have evaluated liver involvement in CD patients. To date, few studies have examined the clinical course and disease severity of adult CD patients who initially presented with elevated liver function tests (LFTs) and were subsequently diagnosed with CD. Addressing this question may help prognosticate future CD patients presenting with LFT abnormalities.

Methods: This is a single center retrospective chart review study at Thomas Jefferson University Hospital. CD severity was measured by histology (Marsh classification), laboratory data (transglutaminase (TTG) IgA antibodies), and time to mucosal healing. Patients with elevated LFTs (eLFT) on presentation were compared to a control group of patients with normal LFTs. Patients without an initial Marsh classification and those with known liver disease and alcohol abuse disorder were excluded. Comparison of CD disease severity was measured using descriptive statistics.

Results: A total of 410 patient charts were reviewed, of which 293 patients were included. Of this group, 18 patients were found to have elevated LFTs on presentation. Notably five of these patients solely presented with elevated LFTs. The remaining 275 patients with normal LFTs on presentation served as control. Mean age for presentation of eLFT cohort was 39.4 years and 42.4 years in the control group. Patients had similar BMI (26.9 kg/m² for eLFT group vs 26.4 kg/m² in the control group) and similar hemoglobin (13.3 g/dL for eLFT group vs 13.5 g/dL in the control group). Patients in the eLFT cohort presented with more severe Marsh score compared to control (77.8% in eLFT group had Marsh 3A or greater vs 61.1% in the control group). Patients eLFT group also presented with higher TTG IgA (47.1 U/mL in eLFT vs 37.8 U/mL in the control group). Interestingly, in patients who presented solely with eLFTs (n=5), 100% presented with Marsh 3A or greater and had a mean TTG IgA of 74.4 U/mL. Time to mucosal healing was longer in the eLFT cohort (47.5 months in eLFT vs 28.6 months in the control group).

Discussion: CD patients with elevated LFTs on initial presentation were found have more severe disease based on worse Marsh classification and higher mean TTG IgA antibodies. Future investigation is needed to understand the underlying mechanism for this process.

	Control (normal LFTs)	Elevated LFTs (eLFT)	Solely Elevated LFTs
Number of Patients	275	18	5
Age at Presentation (Years)	42.4	39.4	48.4
Ethnicity	Caucasian 226 African American 8 Hispanic 3 Asian 3 Native American 0 Unspecified 35	Caucasian 17 African American 0 Hispanic 0 Asian 0 Native American 0 Unspecified 1	Caucasian 5 African American 0 Hispanic 0 Asian 0 Native American 0 Unspecified 0
Sex	Female 194 Male 81	Female 12 Male 6	Female 2 Male 3
BMI at Presentation (kg/m²)	26.4	26.9	25.7
Hemoglobin at Presentation (g/dL)	13.5	13.3	13.1
Marsh Classification at Presentation	Marsh 0 54 Marsh 1 39 Marsh 2 14 Marsh 3A 89 Marsh 3B 59 Marsh 3C 20 Marsh > 3A 61.1%	Marsh 0 3 Marsh 1 1 Marsh 2 0 Marsh 3A 7 Marsh 3B 3 Marsh 3C 4 Marsh > 3A 77.8%	Marsh 0 0 Marsh 1 0 Marsh 2 0 Marsh 3A 0 Marsh 3B 2 Marsh 3C 3 Marsh > 3A 100.0%
TTG IGA at Presentation (U/mL)	37.8	47.7	74.4
Time to Mucosal Healing (months)	28.6	47.5	11.0

Table: Table 1.0: Demographics and disease severity in CD patients with and without elevated LFTs at time of initial presentation

Disclosures:
Christopher Cao indicated no relevant financial relationships.
Ritu Nahar indicated no relevant financial relationships.
Sahaj Mujumdar indicated no relevant financial relationships.
Nicholas Noverati indicated no relevant financial relationships.
Angela Heysel indicated no relevant financial relationships.
Zachary Breslin indicated no relevant financial relationships.
Robin Miller indicated no relevant financial relationships.
Michael Matthews indicated no relevant financial relationships.
Emily Rubin indicated no relevant financial relationships.
Dina Halegoua-DeMarzio indicated no relevant financial relationships.
Jonathan Fenkel indicated no relevant financial relationships.
Stephanie Moleski indicated no relevant financial relationships.
Anthony DiMarino indicated no relevant financial relationships.

Christopher Cao, MD¹, Ritu Nahar, MD¹, Sahaj Mujumdar, MD¹, Nicholas Noverati, MD¹, Angela Heysel, BS¹, Zachary Breslin, BS¹, Robin Miller, ARNP¹, Michael Matthews, ¹, Emily Rubin, RD¹, Dina Halegoua-DeMarzio, MD², Jonathan M. Fenkel, MD¹, Stephanie Moleski, MD¹, Anthony J. DiMarino, MD¹. P0918 - An Investigation of Celiac Disease Severity in Patients Presenting with Elevated Liver Enzymes, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.