Celiac Disease and Hypertransaminasemia

The prevalence of hypertransaminasemia (HT) in children is increased in CD. In one study a total of 114 consecutive pediatric celiac disease patients were studied (60% with classical and 40% with atypical forms).

The authors found HT in 32% of patients, at the time of diagnosis. In fi ve patients, it was the only manifestation of celiac disease (4.3%). Patients with HT were younger (2.9 ± 0.4 year) than patients with normal aminotransferases (5.1 ± 0.5 year) (P = 0.007). A higher percentage of patients with classical celiac disease tends to have abnormal aminotransferases (73%; 95% CI = 65-81%) than do patients with atypical celiac disease (27%; 95% CI = 19-35%) (P = 0.068). A younger age was significantly associated with HT (P = 0.039; OR = 0.8; 95% CI = 0.71-0.99). The aminotransferases normalized with a gluten-free diet in all 35 patients, who were followed-up for an average time of one year.

A significant percentage of adult patients with nonalcoholic fatty liver disease (NAFLD) have no metabolic risk factors and may be related with the concomitant presence of CD. Bardella et al found in a series of 59 patients that tissue transglutaminase antibodies were positive in six (10%) patients and the anti-endomysium in two (3.4%); only two (3.4%), positive for both antiendomysium and anti-transglutaminase, demonstrated celiac disease on histological findings.

After 6 months of a GFD, liver enzymes normalised. Mild liver abnormalities are common in adult patients with celiac disease and usually resolve with a GFD. Four patients with untreated celiac disease and severe liver disease are described by Kaukinnen et al of Finland.

Further, the occurrence of celiac disease was studied in 185 adults with previous liver transplantation using tTG and endomysium antibodies (EMA) testing. Of the four patients with severe liver disease and celiac disease, one had congenital liver fibrosis, one had massive hepatic steatosis and two had progressive hepatitis without any apparent origin. Three patients were even remitted for consideration for liver transplantation. Hepatic dysfunction reversed in all cases when a gluten-free diet was adopted. In the transplantation group, 8 patients (4.3%) had celiac disease. Six cases were detected before the operation: 3 had primary biliary cirrhosis, one had autoimmune hepatitis, one had primary sclerosing cholangitis and one had congenital liver fi brosis. Only one patient had maintained a long-term, strict gluten-free diet.

The serological screening found 2 cases of celiac disease, one with autoimmune hepatitis and the other with secondary sclerosing cholangitis. The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.