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  • Jefferson Adams
    Jefferson Adams

    Celiac Disease and Liver Disorders

    Reviewed and edited by a celiac disease expert.

    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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    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!

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    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.

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    Guest Patricia Roland

    Posted

    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

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    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!!

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    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...

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    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!

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    Guest Robert L. Andrews

    Posted

    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.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He 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 SF 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.

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