S3225 Primary Biliary Cholangitis (PBC) With Concurrent Celiac Disease in Middle-Aged Men: A Case Series

Introduction: Primary biliary cholangitis (PBC) and celiac disease (CD) are autoimmune conditions with distinct manifestations, but they share common immunologic pathways. Co-occurrence of PBC and CD is rare, particularly in middle-aged men, in whom both diseases are less prevalent. This case series reports 5 male patients with concurrent diagnoses of PBC and CD, highlighting unique presentations, management challenges, and outcomes. Case Description/Methods: Five male patients (ages 50-65) presented with symptoms of PBC, including fatigue, pruritus, and elevated liver enzymes, along with gastrointestinal (GI) complaints leading to CD testing. 1. A 62-year-old presented with dermatitis herpetiformis and elevated alkaline phosphatase. He was diagnosed with both PBC and CD. His liver enzymes stabilized with a gluten-free diet and ursodeoxycholic acid (UDCA). 2. A 55-year-old with diarrhea, fatigue, and pruritus was found to have PBC based on AMA positivity and imaging. Concurrent CD was diagnosed via serology and biopsy. Symptoms improved with dietary modification and UDCA. 3. A 50-year-old with weight loss and elevated liver enzymes was diagnosed with PBC and CD. Following a gluten-free diet and PBC treatment, his symptoms improved. 4. A 60-year-old presented with chronic abdominal discomfort. Liver function abnormalities led to a diagnosis of PBC, and CD was confirmed through serology and biopsy. Dietary adjustments combined with UDCA resolved his symptoms. 5. A 58-year-old presented with abdominal bloating and elevated liver markers. Positive AMA and histological findings confirmed PBC and CD. He responded well to a gluten-free diet and medical therapy. Discussion: The presence of PBC and CD in these middle-aged men suggests potential shared autoimmune mechanisms. These cases illustrate that a gluten-free diet can benefit liver function and GI symptoms, supporting earlier testing for CD in PBC patients presenting with GI complaints. While data on concurrent PBC and CD in men is limited, this series reinforces the need for integrated management and further research to clarify their immunologic linkage. Concurrent PBC and CD in middle-aged men is rare but can significantly impact patient management. Screening for CD in PBC patients with GI symptoms and vice versa may optimize outcomes, and dietary modifications have shown positive effects. Further studies could elucidate underlying mechanisms to guide targeted treatment.