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  • Jefferson Adams
    Jefferson Adams

    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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    Guest Christine Phillips

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    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.

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    Guest Irène Mongrain

    Posted

    I didn't know I would be susceptible to liver disease just by having a diagnosis of celiac disease. I now know differently.

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    I think any information concerning the disease is helpful. There are so many different symptoms that manifest at any given time. Thank You.

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    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.

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    Five years after diagnosis with celiac sprue and faithfully on a gluten free diet my liver enzymes did return to normal with fibrosis remaining.

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    Guest Marjorie Wheeler

    Posted

    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

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    Guest Linda Spataccino

    Posted

    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

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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    Author: Hagander B; Berg NO; Brandt L; Nord en A; Sj olund K; Stenstam M.
    Source: Lancet, 1977 Aug 6, 2:8032, 270-2.
    In an attempt to determine the frequency of liver injury in adult coeliac disease (A.C.D.) the case records of 74 consecutive patients were examined. In 13 cases histological sections of the liver were available and in 5 of these there were signs of reactive hepatitis. Histological signs of distinct hepatic injury with cirrhosis and/or chronic active hepatitis were found in 7 other patients. In 5 of these serum-IgA was normal, whereas 16 out of 20 control patients with liver cirrhosis not associated with A.C.D. had raised serum-IgA. Serum-aspartate-aminotransferase and serum-alanine-aminotransferase were determined in 53 patients; 29 had raised concentrations. In 19 patients serum-aminotransferases were repeatedly determined before and during the dietary regimen and there was a significant reduction in enzyme concentrations during treatment. The median concentration of serum-alkaline-phosphatase was also reduced during treatment but not significantly. The histological evidence of liver injury in 16% and the abnormal liver-function tests in 39% of the patients indicate that hepatic injury is common in A.C.D. Since liver-function tests or liver biopsy specimens were available for only about two-thirds of the patients, liver damage in A.C.D. may be more common than indicated by these results. The effect of a gluten-free diet on aminotransferase concentrations indicates that the liver injury may be reversible and suggests that in some A.C.D. patients, progressive liver damage may be prevented by suitable treatment. Since A.C.D. is not always recognized, the diagnosis should be considered in patients with liver disease of unknown aetiology.

    Jefferson Adams
    Celiac.com 06/22/10 - A research team set out to examine gut diseases and prognostic factors tied to non-cirrhotic intrahepatic portal hypertension. The team included C. E. Eapen, Peter Nightingale, Stefan G. Hubscher, Peter J. Lane, Timothy Plant, Dimitris Velissaris, and Elwyn Elias.
    The prognosis for non-cirrhotic intrahepatic portal hypertension (NCIPH) is usually benign. Assessment of a cohort study followed-up at a tertiary referral center leads the research team to hypothesize that gut-derived prothrombotic factors may contribute to the pathogenesis and prognosis of NCIPH.
    The team conducted a retrospective analysis of celiac disease indicators in 34 NCIPH patients. They also looked for associated gut conditions.
    Survival rates for transplant-free NCIPH patients from first presentation of symptoms was 94% (SE: 4.2%) at one year, 84% (6.6%) at 5-years, and 69% (9.8%) at 10-years.
    Sixteen of the patients (53%) showed decompensated liver disease. Three (9%) patients suffered ulcerative colitis, while five of 31 (16%) had clinical celiac disease. Kaplan–Meier analysis showed that celiac disease patients was a predictor of lower transplant-free survival (p = 0.018) rates.
    Multivariable Cox regression analysis revealed that other predictors of reduced transplant-free survival included older age at first NCIPH presentation, hepatic encephalopathy, and portal vein thrombosis.
    Just over one-third (36%) of patients with NCIPH showed substantially higher initial serum IgA anticardiolipin antibody (CLPA), compared to 6% with Budd–Chiari syndrome (p = 0.032 using Fisher’s exact test) and no celiac disease patients without concomitant liver disease (p = 0.007).
    In addition to noting factors affecting prognosis, the team found that just over half (53%) of NCIPH cases resulted in liver failure.
    Source:

    Dig Dis Sci. 2010 May 25. PMID: 20499175

    Jefferson Adams
    Celiac.com 11/25/2010 - Portal hypertension is high blood pressure within the portal vein and its tributaries. Non-cirrhotic intrahepatic portal hypertension (NCIPH) is portal hypertension that occurs within the liver, that is not triggered by cirrhosis. NCIPH is generally regarded to have a benign prognosis.
    A research team examined whether gut-derived prothrombotic factors may contribute to the pathogenesis and prognosis of non-cirrhotic intrahepatic portal hypertension (NCIPH). Their results led them to conclude that gut-derived prothrombotic factors may in fact contribute to the pathogenesis and prognosis of NCIPH.
    The team included C. E. Eapen, Peter Nightingale, Stefan G. Hubscher, Peter J. Lane, Timothy Plant, Dimitris Velissaris, and Elwyn Elias.
    For their study, the team followed a cohort at a tertiary referral center. They analyzed prognostic indicators in 34 NCIPH patients. The team also looked for associated gut disorders.
    Survival rates for transplant-free NCIPH patients from ï¬rst presentation with NCIPH at 1, 5, and 10 years was 94% (SE: 4.2%), 84% (6.6%), and 69% (9.8%), respectively.
    Importantly, 18 patients (53%) showed decompensated liver disease.
    Three patients (9%) showed ulcerative colitis while ï¬ve of 31 patients (16%) tested had celiac disease. Kaplan–Meier analysis showed that the presence of celiac disease was a predictor of shorter transplant-free survival for these patients (p = 0.018).
    Multivariable Cox regression analysis showed that people who were older when ï¬rst presenting with NCIPH, those with hepatic encephalopathy, and those with portal vein thrombosis had lower rates of transplant-free survival
    More than one-third (36%) of NCIPH patients showed elevated levels of initial serum IgA anticardiolipin antibody (CLPA), compared with just 6% with Budd–Chiari syndrome (p = 0.032, Fisher’s exact test) and no patients with celiac disease
    without concomitant liver disease (p = 0.007).
    Under the team's prognostic factors, 53% of NCIPH patients ultimately progress to liver failure, and their data suggest that intestinal disease plays a role in the pathogenesis of intrahepatic portal vein occlusion leading to NCIPH.
    Source:

    Dig Dis Sci. DOI 10.1007/s10620-010-1278-2

    Jefferson Adams
    Celiac.com 07/23/2014 - Transaminasemia develops through various pathways in patients with celiac disease. Currently, there is not much information on risk factors specifically attributable to celiac disease.
    A team of researchers recently set out to determine what factors contribute to hypertransaminasemia in patients with celiac disease. The research team included B. Zanini B, R. Baschè A., Ferraresi, M.G. Pigozzi, C. Ricci, F. Lanzarotto, V. Villanacci, and A. Lanzini.
    They analyzed data collected from consecutive patients referred from January 1997 through December 2009 to the celiac disease clinic at the Spedali Civili of Brescia, Italy. They then used serologic and biopsy analysis to assess the factors influencing hypertransaminasemia in 683 patients with celiac disease (group A), and 304 patients with functional gastrointestinal syndromes (group . Both groups were about the same average age and range.
    The research team detected hypertransaminasemia in 138 patients in group A (20%). Factors associated with the condition included malabsorption (odds ratio [OR], 2.22; P = .004), diarrhea (OR, 1.72; P = .005), and increasing severity of mucosal lesion (Marsh-Oberhuber class; OR, 1.46; P = .001), but not body mass index (BMI) or the blood levels of tissue-transglutaminase antibodies (tTG).
    The team also detected hypertransaminasemia in 22 patients from group B (7%), which they found to be associated with the World Health Organization's BMI categories (OR, 7.9; P < .001). A total of 313 patients from group A had significantly higher levels of tTG at baseline (25.2 ± 16.9 U/L aspartate aminotransferase [AST]) than a similar bunch from group B (20.6 ± 9.9 U/L AST, P < .0001). These levels were related to BMI in group B (P = .0012), but not group A.
    Patients eating gluten-free diets saw levels of AST decrease from 25.2 ± 16.9 U/L to 19.9 ± 6.6 U/L (P < .0001). This decrease was independent of the changes of duodenal histology and tTG and correlated with BMI (P = .0007). Meanwhile, the prevalence of hypertransaminasemia in gluten-free patients decreased from 13% to 4%.
    These study results show that hypertransaminasemia is more common in people with celiac disease than in patients with functional gut syndromes. Also, hypertransaminasemia is related to the severity of the duodenal lesion and malabsorption, but unrelated to BMI.
    By contrast, the control group, with functional gut syndromes, showed a positive correlation between the levels of AST and BMI. This relationship was restored when patients with celiac disease began to follow gluten-free diets.
    Source:
    Clin Gastroenterol Hepatol. 2014 May;12(5):804-810.e2. doi: 10.1016/j.cgh.2013.10.033. Epub 2013 Nov 7.

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