Celiac Disease and Elevated Liver Enzymes: A Review

Abstract

Aminotransferases are commonly found to be elevated in patients with celiac disease in association with two different types of liver dysfunction: cryptogenic liver disorders and autoimmune disorders. The purpose of this review is to discuss the mechanisms by which aminotransferases become elevated in celiac disease, clinical manifestations, and response to gluten-free diet. Many studies have shown that celiac patients with cryptogenic liver disease have normalization in aminotransferases, intestinal histologic improvement and serologic resolution after 6–12 months of strict gluten-free diet. In patients with an underlying autoimmune liver disease, simultaneous treatment for both conditions resulted in normalized elevated aminotransferases. The literature suggests that intestinal permeability may be at least one of the mechanisms by which liver damage occurs. Patients with celiac disease should have liver enzymes routinely checked and treated with a strict gluten-free diet if found to be abnormal. Lack of improvement in patients who have strictly adhered to gluten-free diet should prompt further workup for other causes of liver disease.

Celiac Disease With Autoimmune Hemolytic Anemia and Autoimmune Hepatitis in a Young Child: Case Report and Literature Review

“…Patients with celiac hepatitis improve on institution of gluten free diet (GFD). 11 While patients with autoimmune hepatitis need long term immunosuppression and might need liver transplant. 12 Case reports of autoimmune hepatitis with CD patients have been reported mainly in adult patients at 50 and 60 year of age.…”

Celiac Disease and Elevated Liver Enzymes: A Still Not Fully Defined Pathogenesis

“…We read, with great interest, the comprehensive review by Villavicencio Kim J and Wu GY that systematically addressed the issue of liver enzyme elevation in celiac disease (CD) patients. 1 The Authors reviewed, in detail, the most relevant studies reporting the frequency of liver enzyme elevation in CD patients and the possible causes, discussing the hypothesis that this elevation may be a clue to associated liver disease or an epiphenomenon, possibly secondary to the increased intestinal permeability that is known to characterize CD patients, especially at diagnosis, before starting a gluten-free diet. 2 We would like to add some considerations that, in our opinion, could have implications in the pathogenesis of hepatic injury in CD.…”

“…[3][4][5][6] Among the autoimmune diseases potentially associated with CD, autoimmune hepatitis (AIH) is worthy of mention, as previously reported. 1,3,7 Of considerable interest, it has been reported that celiac patients frequently have anti-filamentous actin IgA antibodies that have shown reliable and significant correlation with villous atrophy. 8 These autoantibodies, although of IgG class, are also known to have very high specificity for AIH.…”

“…We read, with great interest, the comprehensive review by Villavicencio Kim J and Wu GY that systematically addressed the issue of liver enzyme elevation in celiac disease (CD) patients. 1 …”

“…Among the autoimmune diseases potentially associated with CD, autoimmune hepatitis (AIH) is worthy of mention, as previously reported. 1 , 3 , 7 …”