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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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    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.

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    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.

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    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.

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    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 gluten-free/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.

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    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.

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    The gene for hemochromatosis and the gene for celiac disease are both on chromosome six adjacent to one another.

    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.

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    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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  • 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 science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. 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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