There has been a longstanding recognition that celiac disease can be associated with elevated liver enzymes. Two articles provide further information about celiac hepatopathies.
- JPGN 2013; 56: 663-70
- JPGN 2013; 56: 671-74
The first study describes a review of nine studies identified in a MEDLINE search for celiac disease and hypertransamminasemia (HTS) or autoimmune hepatitis (AIH). In total 2046 patients were identified.
- 12% of patients with mild persistent HTS had celiac disease. Among individuals with HTS, the relative risk for celiac disease was 11.59 compared to general population.
- 36% of newly diagnosed children with celiac disease, has elevated aminotransferases. A gluten-free diet normalized transaminases in 77% within 4 to 8 months.
- Among children with celiac disease, 1.4% had AIH. Among children with AIH, 6.3% had celiac disease.
While this meta-analysis had many limitations, it is clear that celiac disease needs to be considered in patients presenting with elevated aminotransferases and in patients with AIH. In addition, other liver conditions like primary biliary cirrhosis and sclerosing cholangitis, which are infrequent in the pediatric population, are more common in patients with celiac disease.
The second study involved both retrospective (1995-2000) and prospective evaluation (2000-2012) of patients followed at a single center. The authors sought to determine the long-term response to immunosuppressive treatment in children with autoimmune hepatitis (AIH) and celiac disease.
In their cohort of 79 AIH patients, 15 (9%) had celiac disease. There was a similar frequency of type 1, type 2 and seronegative AIH among the celiac patients (47%, 20%, and 33%) compared with the entire cohort (55%, 34%, and 11%). All 15 patients responded to treatment with prednisone and azathioprine or cyclosporine, along with a gluten-free diet. When immunosuppressive treatment was withdrawn in 9 patients, 4 relapsed and 5 were maintained off immunosuppression for a mean period of 89 months. A much lower rate of immunosuppression withdrawal was achieved in those AIH patients without celiac disease. 24 of 64 attempted to stop immunosuppression; 5 (8%) were successful.
Take-home point of second study: All AIH patients should be screened for celiac disease as a gluten-free diet may increase the likelihood of withdrawal of immunosuppression.