Liver and Pancreas Disease
The Gluten File



Elevated Liver Enzymes may be associated with Celiac Disease.
Mildly Elevated Liver Transaminase Levels in the Asymptomatic Patient

But did you know....  
While low ALT or AST levels may not be not flagged as any cause for concern by your doctor, this finding may indicate a B6 deficiency~ and possibly underlying pyroluria ~ also associated with gluten and casein sensitivity! This is why it is important to obtain copies of lab reports because sometimes there may be clues that slip under the radar screen of our doctors.

ON MEDSCAPE: 

Prevalence and Causes of Abnormal Liver Function in Patients With Coeliac Disease  2013



PubMed Abstracts

PANCREAS

This report highlights that celiac disease should be considered in the etiological work up of patients with unexplained pancreatitis.
Celiac disease presenting as recurrent pancreatitis and pseudocyst.

PMID: 22964961  Sept 2012


Coeliac disease presenting as acute pancreatitis in a 3-year-old.
PMID: 20828462  Sept 2010


LIVER

Celiac disease markers in patients with liver diseases: a single center large scale screening study.
PMID:23180946 Nov 2012

Primary sclerosing cholangitis (PSC) and primary biliary cirrhosis are the most frequent hepatic disorders in IBD and coeliac disease, respectively.
Liver abnormalities in bowel diseases.
PMID:24090940  Aug 2013

CONCLUSIONS: This study provides further evidence that some patients with CD have a reversible hypertransaminasemia that resolves with a GFD.
The effects of gluten-free diet on hypertransaminasemia in patients with celiac disease.
PMID:23930188 June 2013

Gluten-free diet led to improvement in diarrhea and anemia and to a better control of ascites and other features of liver failure. Some patients with cryptogenic cirrhosis have coexistent celiac disease, and they show response to gluten-free diet. Patients with cryptogenic cirrhosis should be screened for celiac disease.
Celiac disease and chronic liver disease: Is there a relationship?
PMID:23918040  Aug 2013

Celiac disease markers in patients with liver diseases: A single center large scale screening study.
PMID: 23180946 Nov 2012

A pathogenetic link between non-alcoholic fatty liver disease and celiac disease.
PMID: 22740094  June 2012

The liver in celiac disease: clinical manifestations, histologic features, and response to gluten-free diet in 30 patients.
PMID:21685040  July 2011

We report a case of a 36-year-old woman with diagnosis of CD, PBC and H. pylori infection. Strict adherence to gluten-free diet, associated to ursodeoxycholic acid (UDCA) administration and eradication treatment for H. pylori infection, led to a marked improvement of clinical status. Our experience supports the pathogenetic role of increased intestinal permeability in the course of CD and H. pylori infection to induce PBC. Future studies are needed to clarify this link to, and in particular the role played by abnormal intestinal permeability and infectious agents in the pathogenesis of PBC.
Celiac disease, primary biliary cirrhosis and helicobacter pylori infection: one link for three diseases.

PMID: 21244776  Dec 2010

Compared with the general population, the prevalence of celiac autoantibodies in CHB and AIH patients is relatively high, and it is noteworthy that most positive patients were asymptomatic for celiac disease. We suggest screening for celiac disease before and during treatment in patients with viral and autoimmune hepatitis.
The prevalence of celiac autoantibodies in hepatitis patients.
PMID: 20952805  Sept 2010

Transglutaminases in inflammation and fibrosis of the gastrointestinal tract and the liver.
PMID: 19195940 Feb 2009

CONCLUSION: Although rare, severe hepatic damage or failure can develop in association with celiac disease. The etiology is varying and multifactorial. Consequently, children with newly onset celiac disease should be routinely checked for liver function and vice versa, children with severe liver damage should be investigated for untreated celiac disease.
Severe liver damage associated with celiac disease: findings in six toddler-aged girls.
PMID: 19182681   Jan 2009

Although the spectrum of liver abnormalities associated with celiac disease is particularly wide, two main forms of liver damage, namely cryptogenic and autoimmune, appear to be strictly related to gluten-sensitive enteropathy. The most frequent occurrence is a cryptogenic hypertransaminasemia, present in about a half of untreated celiac patients, as an expression of a mild liver impairment characterised by a histological picture of non specific reactive hepatitis (celiac hepatitis) reverting to normal after a few months of gluten withdrawal. In a few cases, a more severe liver injury leading to chronic hepatitis or liver cirrhosis is present. In these patients liver damage can still improve after a gluten-free diet institution. In addition, a close association between celiac disease and autoimmune liver disorders has been largely demonstrated. Indeed, 3%-7% of patients with primary biliary cirrhosis, 3%-6% with autoimmune hepatitis and 2-3% with primary sclerosing cholangitis are affected by celiac disease. Autoimmune liver dysfunction, found in celiac disease, does not usually improve after gluten-free-diet. Presently, it is difficult to establish if the two main kinds of liver injury found in celiac disease (cryptogenic and autoimmune) are discrete entities with a different pathogenesis or if they are an expression of the same disorder where genetic factors and duration of gluten exposure may determine the severity and the pattern of liver injury.
Liver dysfunction in celiac disease.
PMID: 19034259  Dec 2008

Celiac disease is a chronic immune-mediated disorder that may affect several organs. Liver abnormalities are common extraintestinal manifestations of celiac disease. Isolated hypertransaminasemia, with mild or nonspecific histologic changes in the liver biopsy, also known as ''celiac hepatitis'', is the most frequent presentation of liver injury in celiac disease. Both, histologic changes and liver enzymes reverse to normal after treatment with a gluten-free diet in most patients. Celiac disease may also be associated with severe forms of liver disease and/or coexist with other chronic liver disorders (i.e., autoimmune liver diseases). The mechanisms underlying liver injury in celiac disease are poorly understood. Predisposition to autoimmunity by shared genetic factors (i.e., human leukocyte antigen [HLA] genes) as well as the systemic effects of abnormal intestinal permeability, cytokines, autoantibodies, and/or other yet undefined biologic mediators induced by gluten exposure in susceptible persons may play a pathogenic role. The aims of this article are: 1) to review the spectrum of liver injury related to celiac disease and 2) to understand the clinical implications of celiac disease in patients with chronic liver disorders.
Liver involvement in celiac disease.
PMID: 19034257  Dec 2008

The most frequent finding is represented by a cryptogenic hypertransaminasemia, observed in about a half of untreated celiac patients, as an expression of a mild liver dysfunction with a histological picture of nonspecific reactive hepatitis (celiac hepatitis) reverting to normal after 6-12 months of a strict gluten-free diet. In a few cases, when celiac disease is diagnosed, a more severe liver injury, characterized by a cryptogenic chronic hepatitis or liver cirrhosis, is present. In these patients, liver damage can still improve after a gluten-free diet institution. Moreover, a close association between celiac disease and autoimmune liver disorders has been widely demonstrated. Indeed, celiac disease has been found in 3-7% of patients with primary biliary cirrhosis, in 3-6% with autoimmune hepatitis, and in 2-3% with primary sclerosing cholangitis.

PMID: 18496773  May 2008

CONCLUSIONS: Autoimmune liver diseases are frequently associated with celiac disease, but they might remain undiagnosed because of lack of symptoms, because of absence of liver-specific autoantibodies, or because of a misdiagnosis of celiac hepatitis. Acute hepatitis in celiac patients should induce one to suspect an autoimmune origin. Patients with autoimmune liver disease might have a hidden celiac disease, suggesting a rigorous check in any cryptogenic liver disease.
Autoimmune Liver Disease Associated With Celiac Disease in Childhood: A Multicenter Study.
PMID: 18258488  Feb 2008

Isolated hypertransaminasemia with nonspecific histologic changes in a liver biopsy is the commonest hepatic presentation of celiac disease. A gluten-free diet normalizes liver enzymes and histologic changes in most patients. Moreover, celiac disease can coexist with autoimmune liver disorders such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Celiac disease has increasingly been reported with a variety of other liver diseases. Thus, the hepatologist needs to consider celiac disease in the differential of abnormal liver blood tests and to be aware of the clinical implications of this frequent disease in patients with liver disorders.
The liver in celiac disease.
PMID: 17969053  Oct 2007

CONCLUSION: This study suggests that individuals with CD are at increased risk of both prior and subsequent liver disease.

PMID: 17161656 Dec 2006

Celiac disease may present as a cryptogenic liver disorder being found in 5-10 % of patients with a persistent and cryptogenetic elevation of serum aminotransferase activity. In fact, a wide spectrum of liver injuries in children and adults may be related to CD and in particular: (1) a mild parenchymal damage characterised by absence of any clinical sign or symptom suggesting a chronic liver disease and by non-specific histological changes reversible on a gluten-free diet; (2) a chronic inflammatory liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis, that may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive treatment; (3) a severe liver failure potentially treatable by a gluten-free diet. Such different types of liver injuries may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, precocity and duration of exposure to gluten may influence the reversibility of liver damage. A rigorous cross-checking for a asymptomatic liver damage in CD individuals and conversely, for CD in any cryptogenic liver disorder including end-stage liver failure is recommended.
Liver involvement in celiac disease.
PMID: 17006040 Sept 2006

Immunohistochemical studies revealed that the infiltrate was mainly composed of CD8-positive T lymphocytes. In all patients, a gluten-free diet was followed by normalization of liver enzyme levels.[Liver abnormalities in adult celiac disease. Clinicopathologic characterization and outcome after therapy.]
PMID: 16938252 Aug 2006

Elevated transaminases were the most frequently reported abnormality. A gluten-free diet produced resolution of elevated transaminases in 115 of 130 patients. ...Mildly abnormal liver biochemistry is frequent in untreated coeliac disease and may provide a key to the diagnosis. Routine investigations for undiagnosed liver disease should include tissue transglutaminase testing. Left untreated, coeliac-induced hepatitis may rarely progress to end-stage liver disease. Primary biliary cirrhosis is clearly linked to coeliac disease.
Systematic review: the liver in coeliac disease.
PMID: 15740533 Mar 2005

This case report describes the complexity of diagnosing celiac sprue in a patient who presented with features predominantly resembling that of advanced liver disease in the absence of diarrhea.
Celiac sprue presenting as advanced liver disease.
PMID: 15759961 Feb 2005

The results of this study showed a high prevalence of CD in patients with AIH. For this reason, early serological screening testing for CD is strongly recommended for all AIH patients
High prevalence of celiac disease in autoimmune hepatitis detected by anti-tissue tranglutaminase autoantibodies.
PMID: 15645466  2005

Autoimmune hepatitis, cryoglobulinaemia and untreated coeliac disease: a case report.
PMID: 12655265  April 2003

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.

Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.

PMID: 11910339 April 2002

Celiac disease-associated autoimmune cholangitis.
PMID: 12492211  Dec 2002