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Celiac Disease and Liver Disorders

Celiac.com 12/06/2007 - About one person or so in every hundred has celiac disease, which means they suffer from a variety of associated symptoms along with intestinal damage and associated conditions. Research shows a connection between celiac disease and a variety of hepatic disorders. People with celiac disease have a higher instance of certain disorders of the liver. One of the most commonly presented liver problems among celiac patients is isolated hypertransaminasemia with non-specific histologic changes.

Following a gluten-free diet usually returns the liver enzymes and histologic function to their normal state. People with celiac disease can also have unrelated liver conditions, such as primary biliary cirrhosis, autoimmune hepatitis, or primary sclerosing cholangitis.

Most people don’t know much, if anything about celiac disease. Even most people with celiac disease or gluten intolerance face a long learning curve to get up to speed on all of the related issues that concern them. Many people with celiac disease understand that it is a condition in which an auto-immune mediated reaction to the presence of gluten from wheat, rye or barley cause damage to the lining of the intestine, which, if left untreated exposes them to greater risks of certain types of cancer, along with diabetes, and many other conditions.

Even though it is well known among physicians that celiac disease is associated with a variety of other conditions, until recently, those associated with malabsorption were the best documented. Most doctors and researchers believed that these associated conditions were the direct result of, or closely associated with the malabsorption and a compromised nutrient uptake facing untreated celiac patients.  

Recently, however, evidence has begun to emerge that shows celiac disease to be a multi-system disorder that might affect a wide array of organs, including the bones, the heart, the skin, the liver, and the nervous system. Evidence is emerging that shows that beyond damaging the liver outright, celiac disease might also compound the impact of chronic liver diseases when the two occur together.

To better understand the relationship between celiac disease and various liver disorders, researchers Alberto Rubio-Tapia and Joseph A. Murray conducted a review aimed at exploring the spectrum and pathogenesis of liver maladies associated with celiac disease, and to better describe the connection between celiac disease and those liver maladies to better establish a baseline for diagnosis and therapy to help those with chronic liver ailments and to better diagnose and treat celiac disease.

Study Method
In June 2007, the researchers searched PubMed for English-language journals that included full-length articles with the following keywords: celiac disease, sprue, liver disorders, liver involvement, liver tests, hepatitis, cholangitis, and cirrhosis. The researchers looked at 259 cases of patients with chronic hepatitis C, and found that they were three times more likely than a control group of normal volunteers to have celiac disease. The rate was 1.2% versus .4% for the control group.

A second study showed a prevalence of celiac in 534 patients with chronic hepatitis to be 1.3%. Lastly, people with celiac disease show a high rate of non-response to hepatitis B vaccine. Non-response rates were 54% in children with celiac disease and 68% in adult celiacs.

Hemochromatosis
Celiac’s connection to hemochromatosis is twofold. Case histories show that iron overload and diagnosis of hereditary hemochromatosis often follows successful celiac treatment. Also, British patients with celiac disease showed a greater occurrence of mutation in the gene (HFE) controlling hemochromatosis, which might indicate that enhanced iron production is an adaptation to the reduced nutrient absorption associated with celiac. However, a study of Italian celiac patients showed no such increase in mutations. Researchers suspect that any relationship might be coincidental, as both conditions affect large numbers of Caucasians.

Nonalcoholic Fatty Liver Disease
About 10% to 25% of the general population will develop nonalcoholic fatty liver disease.  Nearly 1 in 3 Americans diagnosed with celiac disease is overweight or obese. Two different studies have shown the number of biopsy-confirmed celiac disease in about 3.5%, or over three times that of the normal population.

Liver Transplant
Of 185 patients who underwent transplant, 4.3%, over 4 times the normal population, were positive for celiac disease. In nearly all cases, the cause of the end-stage liver disease requiring transplantation was autoimmune.

Gluten Withdrawal
In patients with nonalcoholic fatty liver disease, a gluten-free diet coincided with a normalization of liver blood test abnormalities, but the exact effects of a gluten-free diet on liver abnormalities in non-alcoholic fatty liver disease and other liver disorders needs to be clarified through further study.

Conclusions
A gluten-free diet is an effective medical therapy for most patients with celiac disease and liver disorders. The effect of a gluten-free diet on the progression of liver diseases associated with celiac disease is less clear. Clearly more studies need to be conducted to further elucidate the relationship between celiac disease and various disorders of the liver.

HEPATOLOGY 2007; 46:1650-1658.

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32 Responses:

 
Suzanne
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said this on
12 Dec 2007 5:08:49 AM PST
Interesting, but it would be helpful to have references included.

 
mary ellsworth kopetchne
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said this on
12 Dec 2007 5:49:53 AM PST
interesting

 
Christine Phillips
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said this on
12 Dec 2007 5:54:58 AM PST
I am so pleased to read an article which directly addresses celiac and liver disease - tragically, my family know first hand the connections. Thank you.

 
Irène Mongrain
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said this on
12 Dec 2007 6:02:43 AM PST
I didn't know I would be susceptible to liver disease just by having a diagnosis of celiac disease. I now know differently.

 
Isabel Cartotenuto MD
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said this on
12 Dec 2007 6:21:31 AM PST
The gene for hemochromatosis and the gene for celiac disease are both on chromosome six adjacent to one another.

 
Chaff
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said this on
03 Jan 2013 9:28:23 PM PST
Awesome! This is good to know, since I have both hemochromatosis and celiac (and have Irish ancestry). Nice bit of protection from Mother Nature for the Celts.

 
Wendy Nielson
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said this on
12 Dec 2007 7:22:11 AM PST
I think any information concerning the disease is helpful. There are so many different symptoms that manifest at any given time. Thank You.

 
Joyce Petree
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said this on
12 Dec 2007 8:19:22 AM PST
We need all the latest info and research data for this disease as it is far more complex and far more damaging than what appears in most information available to patients suffering from it.

 
Ann Turner
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said this on
12 Dec 2007 8:53:26 AM PST
Five years after diagnosis with celiac sprue and faithfully on a gluten free diet my liver enzymes did return to normal with fibrosis remaining.

 
an unknown user
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said this on
12 Dec 2007 9:49:10 AM PST
Thank you for keeping the celiacs updated

 
Marjorie Wheeler
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said this on
12 Dec 2007 1:28:49 PM PST
I had increased liver function for 16 years prior to being properly diagnosed with Celiac. I even had a liver biopsy and told I had auto-immune hepatitis. Great Article

 
Anneliese Potter
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said this on
13 Dec 2007 4:37:28 PM PST
Find this information useful since I have increased liver function studies.

 
Linda Spataccino
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said this on
13 Dec 2007 4:39:56 PM PST
My daughter was recently diagnosed with celiac so we are ever learning. Right before she was diagnosed with celiac they had found a cyst on her liver. I wonder if there is a connection. Thanks for the info

 
Derrick Mayer
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said this on
13 Dec 2007 10:22:54 PM PST
I have Meniere's disease, a auto-immune inner ear disease, and BTB a celiac, but zilos drug is now a CONTROLLED substance, so having trouble proving celiac, but my 2 year diarrhea has ended when I started gluten free diet. And dark field microscopy has confirmed malabsorption and parasites in my blood cells. I am at my wits end, gaining weight, but eat 1 or 2 meals a day and Meniere's symptoms to boot!

 
Ed Yellin
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said this on
14 Dec 2007 9:07:47 AM PST
I'm glad to see more research on the impact of celiac disease on organ systems other than the GI system. I would like to see references to all the organs cited.

 
Sam Thomson
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said this on
14 Dec 2007 9:25:25 AM PST
For approx 5 years before I was diagnosed w/ Celiac my liver enzymes we chronically elevated and the first question asked by MD's was, 'How much do you drink?' But when I started my gluten free diet the liver enzymes normalized within weeks.

 
Janelle
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said this on
14 Dec 2007 1:09:38 PM PST
Who conducted this research? Could you include the authors and organizations?

 
Kathleen Williams
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said this on
19 Dec 2007 7:38:09 PM PST
Could not believe that now the liver is involved with Celiac Disease - amazing information - and information is protection for all us Celiacs. Thanks you.

 
nadia alghazir
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said this on
27 Dec 2007 3:52:18 AM PST
I am a pediatric diabetologist and wee see a lot of celiac patients and it will be good to check the liver transaminase among those celiac and diabetes.

 
CAROLINE A. VERBECK
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said this on
03 Jan 2008 1:51:11 PM PST
I HAD A LIVER TRANSPLANT JUNE 2005----ALSO CELIAC DISEASE NOTED 2003----I WAS NEVER AWARE OF ANYTHING PRIOR--
THANK YOU FOR THIS E-MAIL---

 
Patricia Roland
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said this on
09 Jan 2008 8:56:21 PM PST
I have been diagnosed for 34 yrs and have been on and off my diet. Last 5 yrs. can't have rice or yeast. Just got diagnosed with fatty liver. It's been a blessing finding your site

 
Jeff Kelly
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said this on
12 Feb 2008 2:19:06 PM PST
After 45 years not knowing what was wrong with me started a gluten free diet. Major improvement...recently liver enzymes elevated, bowel trouble, feel lousy. There is evidently a connection with liver disease. This is very tragic. I live in a place where they don't know a darn tootin' thing about such a connection...thanks for this!!

 
Miriam
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said this on
16 Sep 2008 11:01:15 PM PST
I can't seem to find a definition of 'hypertransaminasemia' anywhere, but when I was 12 had elevated liver enzymes, jaundice in my eyes, and general sickness, so I was told I had a form of hepatitis. I was negative for every virus they tested me for, though, and, as far as I know, it resolved after about a month. So I'm wondering if what I had should technically be called 'hypertransaminasemia' or 'non-alcoholic fatty liver disease' or something like that.
My sister has just had a positive blood test for celiac, and I haven't been tested yet, but I'm really curious now if I might have it to and if my liver problems were related to it. I haven't been sick the same way since then, but I don't think my liver enzymes have been tested either. I'm curious to see if anyone has any thoughts about this situation...

 
Eric Young
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said this on
09 Mar 2009 8:49:23 AM PST
My doctor has just found what appear to be problems involving my liver. I was at a loss of what would be the cause, but strongly suspected celiac. My doctor is pushing aside my questions about a possible connection (I suspect she doesn't really know that much about celiac) and has me going to a liver specialist. I plan on discussing the possible connection with that specialist, hoping that he/she will have an understanding of celiac disease. These articles from Celiac.com come at an opportune time!

 
Robert L. Andrews
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said this on
28 Apr 2011 3:45:33 PM PST
I would especially like to see a reference for the comment "Case histories show that iron overload and diagnosis of hereditary hemochromatosis often follows successful celiac treatment." I have celiac disease and I'm citing this article as one of the reasons why I believe I should be tested for hemochromatosis.

 
Nicole
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said this on
07 Aug 2011 10:27:37 AM PST
Upon doing some research for a paper on this subject, the url for the reference the author omitted is:
www.ikp.unibe.ch/lab2/rubio2007.pdf

 
BobL
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said this on
22 Sep 2011 6:31:57 PM PST
Very Interesting. 11 years ago I found out I had a fatty liver. Since then enzyme levels were always elevated. I was diagnosed with Celiac 7 months ago. Had my normal blood work done because my Primary Physician was concerned about my enzyme levels. Most recent blood work was done about 3 months after going gluten free and my levels were normal, first time in 11+ years. I certainly believe that there is some kind of connection.

 
Blanca
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said this on
22 Nov 2011 11:34:13 AM PST
This a great article! I had so many seemingly unrelated symptoms, and after a test came back that said my liver levels were elevated I was very worried. It took doctors a while to connect it with celiac so I am glad more is known know about it.

 
Chris
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said this on
01 Dec 2011 1:18:38 AM PST
I was the reverse to what this article says and to what other suspect. I was diagnoses with hemochromatosis after my father was diagnosed with it, but the doctor said there was no need for me to do anything about it because for some reason my iron levels were normal. 12 months later, I was diagnosed with celiac.

 
Brianna
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said this on
08 Jan 2012 1:53:58 PM PST
OBVIOUSLY celiac disease can cause damage to the liver. The undigested wheat will ferment and turn into alcohol! At least that's what this on article told me... I fear I may have celiac and milk intolerance. I have ADD, my twin brothers have ADHD. My 20 year old bro is develop mentally delayed... As soon as I put myself on a GF/MF diet, my symptoms went away. My mom does not believe it, though. I can't wait for my intolerance test. Good article. P.S. My brothers probably just have calcium overdose.

 
Judy
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said this on
02 Jan 2013 4:10:26 PM PST
I have had digestive problems, acne and difficulty losing weight for many years. For the past several years I also came down with other symptoms such as spastic colon, peripheral neuropathy and now extremely elevated liver enzymes which caused me much worry. My doctor treated me as if I had been promiscuous because of the elevated liver enzymes, which I am not... I have been 100% faithful to my husband of 27 years... anyway, I insisted on an ultrasound because I was having a great deal of pain on my right side and they found that I have a fatty liver. I do not drink, and always thought of myself as a healthy eater. I could not understand why I would have this now. I came across a doctor on Youtube who cured herself of MS through the Paleo diet, no grains at all because of the effects grains have on your body. I decided to try it and I have lost a great deal of weight and have felt so much better. I now know that I have celiac disease because it is also attributed to neuropathy as well. This article has helped me understand my problems so much... the doctor on the other hand... no.

 
Debbie
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said this on
31 Aug 2013 8:57:31 PM PST
I am In the beginning stages of self diagnosis. I am 42 years old, I have had intestinal symptoms ranging from mild to severe my whole life and been diagnosed with IBS. I have had liver disorder, my gallbladder removed, and diagnosed with fatty liver disease years ago, and my doctor also accused me of excessive drinking, of which I have never. I was recently diagnosed with diabetes. Recently I started a gluten free diet, only because of symptoms my son was having, and my symptoms have been better then ever. Very interesting article just very sad that I have all the classic symptoms and my doctors have sent me all over and never even mentioned celiac.




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