981 IGA ANTIBODIES AGAINST DEAMIDATED GLIADIN PEPTIDES AND TISSUE-TRANSGLUTAMINASE IN PATIENTS WITH CHRONIC LIVER DISEASES

POSTERS Our aim was to identify risk factors for SSC development and to find out possibilities to lower this risk. Methods: Retrospective analysis of 54 patients after intensive care unit (ICU) treatment, who were diagnosed as SSC via endoscopic retrograde cholangiopancreaticography (ERCP) after cardio-thoracic surgery (CTS) interventions (n = 21), septic complications (n = 13), poly-trauma (n = 11), and others (n = 9). Bile samples for microbiological analysis were obtained during ERCP. Results: Thirty-three patients either died (n = 27) or needed liver transplantation (n = 6) were compared to surviving patients (n = 21). We identified septic complications, fever before ERCP, hemodialysis, elevated bilirubin, a high MELD Score and low albumin as risk factors. The diagnostic success rate was 30% for abdominal ultrasound, 36% for liver biopsies and 100% for ERC with only one patient who developed mild post-ERCP pancreatitis. However, the time gap between onset of severe cholestasis and ERCP diagnosis was 74±68 days (range 8–305). Microbiological analysis of bile revealed colonization in all bile samples but one. An escalation of antimicrobial therapy was necessary in 28% of cases. Conclusion: SSC in CIP is a rare but unfortunately frequently fatal disease. The diagnostic (and therapeutic) procedure of choice is ERCP, but it often comes late because other causes for cholestasis are taken into account. If one or more of the above summarized risk factors are present, an early ERCP should be considered and bile should be obtained for microbiological analysis to adjust the antibiotic regime. 980 ATYPICAL PRESENTATION AND AGGRESSIVE DISEASE COURSE IN MALE PBC PATIENTS M. Abdulkarim, C. Wiegard, C. Glaubke, A.W. Lohse, C. Schramm, C. Weiler-Normann. I. Medizinische Klinik und Poliklinik, Universit¨ atsklinikum Hamburg-Eppendorf, Hamburg, Germany E-mail: [email protected] Introduction: Primary biliary cirrhosis (PBC) is a chronic granulomatous liver disease. More than 90% of the affected patients are of female sex. We aimed to assess the difference in presentation and course of disease of PBC between male and female patients in patients seen at our tertiary care center. We conducted a retrospective study identifying 23 consecutive male patients with PBC treated at our center in the past 5 years. 46 age-matched female controls were identified. Result: Five male patients (22.7%) suffered from PBC-typical complaints compared to 31 female patients (60%) (M:F: Pruritus 3(13%):15(28%), fatigue 5(22.7%):14(27%), joint pain 2(9%):11(21%), jaundice 1(4.5%):0(0%)). Accompanying other autoimmune diseases were significantly less frequent in males (n = 2, 9%) than in females (n = 30, 57%). Male patients had higher liver enzymes at presentation than female patients (GGT = 336 U/l vs. 204 U/l, AP 188 U/l vs. 145 U/l, and treatment response to UDCA (AP = 150 U/l vs. 112 U/l (p = 0.0252)) was worse as compared to females. The number of male patients suffering from secondary autoimmune hepatitis was higher compared to female patients (9 (40.9%) vs. 15 (28.8%)). Interestingly, three male patients were diagnosed with hepatocellular carcinoma compared to 1 in the total cohort of more than 300 females, suggesting a higher rate of liver cirrhosis in male versus female patients with PBC. Discussion: The often asymptomatic presentation may delay the diagnosis of PBC in male patients. Once diagnosed, male PBC seems to have a more aggressive course than female PBC including a higher rate of hepatocellular carcinoma. Therefore, more intensive screening as well as more aggressive treatment strategies should be considered for male patients with PBC.

981 IGA ANTIBODIES AGAINST DEAMIDATED GLIADIN PEPTIDES AND TISSUE-TRANSGLUTAMINASE IN PATIENTS WITH CHRONIC LIVER DISEASES N.K. Gatselis1 , K. Zachou1 , G.L. Norman2 , G. Tzelas3 , S. Gabeta1 , M. Speletas4 , G.K. Koukoulis5 , G.N. Dalekos1 . 1 Department of Medicine and Research Lab of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece; 2 INOVA Diagnostics, San Diego, CA, USA; 3 Department of Gastroenterology, University Hospital of Larissa, 4 Department of Immunology and Histocompatibility, 5 Department of Pathology, Medical School, University of Thessaly, Larissa, Greece E-mail: [email protected] Background and Aims: Over the years celiac disease (CD) serology has evolved, with the identification of newer and more specific autoantibodies such as those against tissue-transglutaminase (antitTG) and deamidated gliadin peptides (anti-DGP). We investigated herein the prevalence and clinical significance of IgA anti-DGP and IgA anti-tTG antibodies and their possible correlation in patients with chronic liver diseases. Methods: We studied 668 patients without gastrointestinal symptoms (426 chronic viral hepatitis, 94 autoimmune liver diseases, 61 alcoholic liver disease, 46 non-alcoholic fatty liver disease, 41 with other liver disorders). The CD-related IgA antibodies were determined by commercially available ELISAs (INOVA Diagnostics, San Diego, CA). Patients positive for at least one autoantibody were invited to undergo a small-intestinal biopsy and HLA-DQ allele typing. Results: Anti-DGP were detected in 57/668 (8.5%) and anti-tTG in 38/668 (5.8%) patients (p = 0.05). Anti-tTG were more prevalent in patients with autoimmune liver diseases (p < 0.01). Fifty-two were anti-DGP (+)/anti-tTG (−), 34 anti-DGP (−)/anti-tTG (+), and 5 anti-DGP (+)/anti-tTG (+). Anti-DGP positivity was associated with increased age (p < 0.05), the presence of cirrhosis (p < 0.05) and increased levels of IgA (p < 0.05). Anti-tTG antibodies were associated only with cirrhosis (p < 0.05). Small intestinal biopsy and HLA-DQ typing was performed in 14/52 anti-DGP (+)/anti-tTG (−), 13/34 anti-DGP (−)/anti-tTG (+) and 2/5 anti-DGP (+)/anti-tTG (+) patients. Histology and HLA-typing compatible with CD was revealed in 4/14, 0/13 and 2/2 patients respectively. Conclusions: Although the detection of both CD-related autoantibodies were increased and related with the presence of cirrhosis, anti-DGP seems to be more specific marker for unmasking occult forms of CD in patients with chronic liver diseases.

Journal of Hepatology 2012 vol. 56 | S225–S388

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