Systematic Review: The Liver in Coeliac Disease
Background: For over a decade isolated reports have noted liver histology and biochemistry changes in patients with coeliac disease. The prevalence and response to treatment is clinically important.
Aim: To outline the frequency and significance of liver abnormalities in coeliac disease.
Methods: A Medline search using Ovid-Coeliac/Coeliac (exp) and liver disease (exp) was completed of English references published during 1966-June 2003. Bibliographic references and other appropriate sources were also searched.
Results: Six studies reported liver biochemistry in 591 patients; 248 patients had abnormal results. Elevated transaminases were the most frequently reported abnormality. A gluten-free diet produced resolution of elevated transaminases in 115 of 130 patients. There was a greater than expected association with primary biliary cirrhosis and advanced liver disease.
Conclusions: 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. The full story of these linkages is yet to be written.
There is growing evidence that a largely silent chronic liver abnormality 'cryptogenic-elevated transaminases' is frequently associated with untreated coeliac disease in both children and adult patients. There is also a strong association of primary biliary cirrhosis and coeliac disease. The link to cirrhosis and other structural changes is less evident. This nexus requires greater recognition as the response to a gluten-free diet is excellent. In contrast, untreated there is evidence of occasional severe liver disease including cirrhosis and mistreated there are the risks from long-term steroids for misdiagnosed 'autoimmune hepatitis'.
Background: For over a decade isolated reports have noted liver histology and biochemistry changes in patients with coeliac disease. The prevalence and response to treatment is clinically important.
Aim: To outline the frequency and significance of liver abnormalities in coeliac disease.
Methods: A Medline search using Ovid-Coeliac/Coeliac (exp) and liver disease (exp) was completed of English references published during 1966-June 2003. Bibliographic references and other appropriate sources were also searched.
Results: Six studies reported liver biochemistry in 591 patients; 248 patients had abnormal results. Elevated transaminases were the most frequently reported abnormality. A gluten-free diet produced resolution of elevated transaminases in 115 of 130 patients. There was a greater than expected association with primary biliary cirrhosis and advanced liver disease.
Conclusions: 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. The full story of these linkages is yet to be written.
There is growing evidence that a largely silent chronic liver abnormality 'cryptogenic-elevated transaminases' is frequently associated with untreated coeliac disease in both children and adult patients. There is also a strong association of primary biliary cirrhosis and coeliac disease. The link to cirrhosis and other structural changes is less evident. This nexus requires greater recognition as the response to a gluten-free diet is excellent. In contrast, untreated there is evidence of occasional severe liver disease including cirrhosis and mistreated there are the risks from long-term steroids for misdiagnosed 'autoimmune hepatitis'.
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