Factors That Contribute to Hypertransaminasemia in Patients With Celiac Disease or Functional Gastrointestinal Syndromes

Zanini, Bárbara; Baschè, R.; Ferraresi, Alice; Pigozzi, Marie Graciella; Ricci, Chiara; Lotti, Francesco; Villanacci, Vincenzo; Lanzini, Alberto

doi:10.1016/j.cgh.2013.10.033

Cited by 26 publications

(37 citation statements)

References 20 publications

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“…However, a prevalence up to 42% has been reported for hypertransaminasemia in the CD population. The mechanisms predisposing to hypertransaminasemia in CD have been associated with the clinical diagnosis of malabsorption and with the increasing severity of duodenal lesion [78]. Most of the evidence supports a beneficial effect of the GFD on the liver affection in CD [76,77,78].…”

Section: Liver Affection In CDmentioning

confidence: 99%

Extraintestinal Manifestations of Celiac Disease

Pinto-Sanchez¹,

Berčík²,

Verdú³

et al. 2015

Dig Dis

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Case finding for celiac disease (CD) is becoming increasingly common practice and is conducted in a wide range of clinical situations ranging from the presence of gastrointestinal symptoms to failure to thrive in children, prolonged fatigue, unexpected weight loss and anemia. Case finding is also performed in associated conditions, such as autoimmune thyroid disease, dermatitis herpetiformis and type 1 diabetes, as well as in patients with irritable bowel syndrome, unexplained neuropsychiatric disorders and first-degree relatives of patients with diagnosed CD. This aggressive active case finding has dramatically changed the clinical characteristics of newly diagnosed patients. For instance, higher numbers of patients who present with extraintestinal symptoms are now being diagnosed with CD. Current recommendations state that due to a high risk for complications if the disease remains undiagnosed, patients with extraintestinal symptoms due to CD require appropriate diagnosis and treatment. Despite criticism regarding the cost-effectiveness of case finding in CD, such an aggressive approach has been considered cost-effective for high-risk patients. The diagnosis of CD among patients with extraintestinal symptoms requires a high degree of awareness of the clinical conditions that carry a high risk for underlying CD. Also, understanding the correct use of specific serology and duodenal histology is key for an appropriate diagnostic approach. Both procedures combined are able to confirm diagnosis in the vast majority of cases. However, in certain circumstances, serology and even duodenal histology cannot confirm or rule out CD. A common cause of negative IgA serology is IgA deficiency. For such eventuality, IgG-based serological tests can help confirm the diagnosis. Importantly, some histologically diagnosed cases still remain seronegative despite exclusion of IgA deficiency. On the other hand, duodenal histology may be normal despite the presence of CD-specific antibodies and active CD. This has been clearly demonstrated in some cases of untreated dermatitis herpetiformis, but may also be due to the patchy condition of CD or lesions that are not adequately recognized by nonexpert endoscopists and/or pathologists. The effectiveness of agluten-free diet depends on the clinical end point addressed. A good example is the outcome of bone loss. While risk for fracture normalizes after the first year of dietary treatment, bone parameters measured by densitometry may not be normalized in the long-term follow-up. Moreover, it is still unclear how far an early gluten-free diet will positively affect associated autoimmune diseases like type 1 diabetes and autoimmune thyroiditis.

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Section: Liver Affection In CDmentioning

confidence: 99%

Extraintestinal Manifestations of Celiac Disease

Pinto-Sanchez¹,

Berčík²,

Verdú³

et al. 2015

Dig Dis

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“…En Brasilia, entre 2045 donantes de sangre, 62 mostraron resultados positivos al examen de anticuerpos gliadina y dos presentaron EmA positivo (22). En los individuos con enfermedad celíaca la edad promedio varió entre 32 y 37 años, de manera similar a la encontrada en el presente estudio (23)(24)(25). Se sabe que esta enfermedad es más común en las mujeres, llegando del 73% al 80%; este patrón ha sido descrito por muchos autores (23,25,26).…”

Section: Discussionunclassified

“…Al seguir una dieta libre de gluten, los niveles de AST en suero disminuyeron de 25,2 ± 16,9 U/L al inicio a 19,9 ± 6,6 U/L (p <0,0001). Un efecto similar se observó para ALT (28,1 ± 21,7 versus 20,4 ± 9,5 U/L, p <0,0001) y hubo una reducción de la prevalencia de hipertransaminasemia del 13% al 4% (24). Al igual que en los estudios descritos anteriormente, este estudio mostró que la ALT disminuyó después de una dieta libre de gluten, pero el mismo comportamiento no se observó con la AST.…”

Section: Discussionunclassified

“…Los pacientes con hipertransaminasemia tienen un aumento de la permeabi-34,6% de los pacientes mostró niveles elevados de ALT por encima del tercil superior (ALT ≥50 U/L). La hipertransaminasemia se encontró entre el 9,18% y el 40,4% de las personas con enfermedad celíaca (23)(24)(25)(26)29). El comportamiento de ALT en este grupo de pacientes, después de una dieta libre de gluten, ha sido analizado en diversos estudios (23)(24)(25)(26)29,30).…”

Section: Discussionunclassified

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El efecto de la dieta libre de gluten en la alanina- aminotransferasa (ALT) en pacientes celíacos

Hatanaka

Silva

Dantas-Corrêa

et al. 2016

Rev. Colomb. Gastroenterol.

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El efecto de la dieta libre de gluten en la alaninaaminotransferasa (ALT) en pacientes celíacosThe effect of a gluten-free diet on alanine aminotransferase (ALT) in celiac patients ResumenIntroducción: la enfermedad celíaca es una enfermedad autoinmune provocada por la ingestión de gluten que afecta aproximadamente al 0,5%-1% de la población mundial. Las señales extraintestinales incluyen elevados niveles de alanina-aminotransferasa (ALT). Objetivo: evaluar los efectos de una dieta libre de gluten en los niveles ALT en pacientes con enfermedad celíaca. Métodos: este estudio transversal se llevó a cabo en la clínica ambulatoria de gastroenterología de un hospital universitario. Resultados: se incluyeron veintiséis pacientes con enfermedad celíaca con edad de 34,1 ± 11,4 años; 15,4% fueron hombres. Los sujetos del estudio tenían un nivel promedio de ALT de 54,6 ± 36,3 (mediana 40,5) U/L. Hubo una mayor proporción de individuos con hepatitis B en el grupo con ALT ≥50 U/L en comparación con sujetos con ALT <50 U/L. Entre los pacientes evaluados después del tratamiento con dieta libre de gluten se observó una reducción significativa de los valores de ALT (36,0 versus 31,0 U/l; p= 0,008). Conclusión: el treinta y cinco por ciento de los pacientes con enfermedad celíaca tenía ALT por encima del tercil superior. Se encontraron niveles más altos de ALT en pacientes con hepatitis viral B y en aquéllos que no se adhirieron a la dieta. Hubo una reducción de aminotransferasas como resultado de una dieta libre de gluten. Palabras claveTransaminasas, enfermedad celíaca, alanina-transaminasa, aminotransferasas aspartato, dieta, libre de gluten. AbstractIntroduction: Celiac disease is an autoimmune disease triggered by ingestion of gluten. It affects approximately 0.5% to 1% of the world population. Extra intestinal manifestations include elevated alanine aminotransferase (ALT) levels. Objective: The objective of this study was to evaluate the effects of a gluten-free diet on ALT levels in patients with celiac disease. Methods: This cross-sectional study was conducted in the gastroenterology outpatient clinic of a university hospital. Results: Twenty-six patients with celiac disease were included. Average patient age was 34.1 ± 11.4 years, and 15.4% of the patients were men. Study subjects had a mean ALT level of 54.6 ± 36.3 U/L (median 40.5). There was a higher proportion of individuals with hepatitis B in the group with ALT ≥ 50 U/L than in the group of subjects with ALT < 50 U/L. Among patients tested after treatment with a gluten-free diet, we observed a significant reduction in ALT values (36.0 vs. 31.0 U/L; P = 0.008). Conclusion: Thirty-five percent of celiac disease patients had ALT levels above the upper tertile. Higher ALT levels were found in patients with viral hepatitis B and in those who do not adhere to the diet. There was a reduction of aminotransferases with a gluten-free diet.

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“…One proposed explanation for hepatic involvement in these patients is that the increased intestinal permeability may ease the entry of toxins, antigens, and inflammatory substances (cytokines and/or autoantibodies) to the portal circulation that, subsequently, play a role in liver injury [13].…”

Section: Discussionmentioning

confidence: 99%

Diarrhea and Symptomatic Coagulopathy: An Uncommon Presentation of Celiac Disease

Eusébio¹,

Caldeira²,

Cabrita³

et al. 2015

J Gastrointest Dig Syst

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A 39 year-old female was admitted to the emergency department due to watery diarrhea and weight loss for 3 weeks. Over the last days she also presented menorrhagia and vomiting. Physical examination revealed skin paleness and slight dehydration.Laboratory investigation showed microcytic anemia (hemoglobin 10,6 g/dL), multiple nutricional deficiencies and hypertransaminasemia (aspartate aminotransferase 120 UI/L and alanine aminotransferase 201 UI/L). International normalized ratio was greatly increased (11,87: more than 10 times the upper limit of normal) as well as activated partial thromboplastin time (100 seconds). Additional studies were positive for increased antitissue transglutaminase (above 300 UA/mL) and attenuation of duodenal villous pattern on upper endoscopy. Duodenal biopsies confirmed celiac disease. Coagulopathy was treated with vitamin K intravenously with normalization of coagulation assays. Following a gluten-free diet the patient became asymptomatic with no bleeding recurrence and achieved laboratory and histological recovery.Despite being a well-characterized disorder, celiac disease remains underdiagnosed. This case highlights the several manifestations of celiac disease that may trigger the diagnosis. Furthermore, bleeding due to vitamin K malabsorption is a rare complication of the disease and is herein presented.

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Factors That Contribute to Hypertransaminasemia in Patients With Celiac Disease or Functional Gastrointestinal Syndromes

Cited by 26 publications

References 20 publications

Extraintestinal Manifestations of Celiac Disease

Extraintestinal Manifestations of Celiac Disease

El efecto de la dieta libre de gluten en la alanina- aminotransferasa (ALT) en pacientes celíacos

Diarrhea and Symptomatic Coagulopathy: An Uncommon Presentation of Celiac Disease

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