Celiac.com 03/29/2025 - Celiac disease is an autoimmune condition that primarily affects the small intestine but can also have widespread effects on other organs, including the liver. Some individuals develop liver damage without a clear underlying cause, a condition known as cryptogenic cirrhosis. A recent study published in The American Journal of Gastroenterology explores the link between celiac disease and cryptogenic cirrhosis, investigating how common celiac disease is in these patients and whether a gluten-free diet can improve liver function.

Study Overview

The researchers screened 300 individuals with chronic liver disease that had no known cause. After further evaluation, 232 patients were confirmed to have cryptogenic cirrhosis. These patients underwent blood tests to check for antibodies associated with celiac disease, as well as small intestine biopsies to confirm the diagnosis.

Out of the 232 patients:

• 11 were diagnosed with celiac disease based on biopsy results
• 5 had elevated celiac disease-related antibodies but did not show enough intestinal damage to be definitively diagnosed
• 216 had no signs of celiac disease

For comparison, the study also included a control group of 44 patients with cryptogenic cirrhosis who did not have celiac disease.

Key Findings

Prevalence of Celiac Disease in Cryptogenic Cirrhosis

The study found that about 4.7% of the cryptogenic cirrhosis patients had biopsy-confirmed celiac disease, while 6.9% had positive blood tests indicating possible celiac disease. This suggests that celiac disease might be an overlooked cause of liver disease in some individuals.

Liver Health and the Gluten-Free Diet

To evaluate the impact of diet, researchers tracked two groups for one year:

1. Patients with celiac disease who adopted a gluten-free diet
2. Patients with cryptogenic cirrhosis without celiac disease who followed standard medical care

The results showed that patients with celiac disease who removed gluten from their diet experienced significant liver function improvement. Key measurements of liver health, including the Model for End-Stage Liver Disease score and Child-Pugh score, improved in the gluten-free diet group. In contrast, the patients who did not have celiac disease and followed standard care showed worsening liver function over time.

Additionally, individuals with celiac disease who adhered to a gluten-free diet had fewer complications related to liver disease. The death rate was similar between groups, suggesting that while a gluten-free diet did not reduce overall mortality in the short term, it significantly improved quality of life and liver function.

Why This Study Matters

Uncovering Hidden Celiac Disease in Liver Patients

For individuals with unexplained liver disease, this study highlights the importance of testing for celiac disease. Many doctors may not immediately consider celiac disease when diagnosing liver issues, but this research suggests that it could be a contributing factor in a notable percentage of cases.

A Gluten-Free Diet Can Be a Game Changer

One of the most promising takeaways from this study is that treating celiac disease with a strict gluten-free diet can lead to real improvements in liver health. Unlike many liver diseases that have limited treatment options, this study suggests that dietary changes alone can make a significant difference for some patients.

Implications for People with Celiac Disease

For individuals who already have a celiac disease diagnosis, this study serves as a reminder that liver health should not be overlooked. If someone with celiac disease is experiencing abnormal liver test results or signs of liver damage, it may be worth discussing cryptogenic cirrhosis with a healthcare provider.

Final Thoughts

This study sheds light on an important but underrecognized connection between celiac disease and liver health. It suggests that celiac disease testing should be considered for individuals with unexplained liver disease, as identifying and managing celiac disease through a gluten-free diet can lead to meaningful health improvements. For those living with celiac disease, it reinforces the importance of dietary adherence—not just for digestive health but for overall well-being, including liver function.

Read more at: journals.lww.com

Celiac.com 01/16/2025 - Celiac disease, an autoimmune condition triggered by gluten consumption, is known for its gastrointestinal and systemic impacts. Recent research indicates potential connections between celiac disease and chronic liver disease. This summary highlights findings from a large-scale Swedish study that explored whether celiac disease increases the long-term risk of chronic liver disease and major liver-related complications.

Study Methods and Design

The study utilized data from the Swedish ESPRESSO cohort, incorporating over 48,000 individuals diagnosed with celiac disease through intestinal biopsy between 1969 and 2017. These participants were compared to nearly 232,000 matched individuals from the general population. Researchers followed these groups until 2021 to evaluate the incidence of chronic liver disease, including conditions such as autoimmune liver disease, metabolic dysfunction-associated liver disease, alcohol-related liver disease, and viral hepatitis. Major adverse liver outcomes, such as cirrhosis, liver cancer, liver transplantation, and liver-related death, were also assessed.

Elevated Risk of Chronic Liver Disease

Celiac disease patients exhibited a twofold higher risk of developing chronic liver disease compared to the general population. This increased risk persisted for over 25 years after diagnosis. For every 110 individuals with celiac disease, one additional case of chronic liver disease was observed within this timeframe.

Specific Liver Conditions

The study found varying levels of increased risk depending on the type of liver disease:

Autoimmune Liver Disease: Patients with celiac disease were nearly five times more likely to develop autoimmune liver conditions.

Metabolic Dysfunction-Associated Liver Disease: This condition was 2.5 times more common in individuals with celiac disease.

Alcohol-Related Liver Disease: A moderate increase in risk (1.5 times) was noted for alcohol-related liver disease.

Major Liver Complications

Celiac disease patients faced a 54% higher risk of major adverse liver outcomes, including liver failure, liver-related death, and liver cancer.

Factors Influencing Liver Disease Risk

Diagnostic Bias

The elevated risk was most pronounced shortly after celiac diagnosis, potentially due to diagnostic workups that identified existing liver abnormalities. However, even after accounting for this, the risk remained elevated for decades.

Genetics and Autoimmune Links

The study highlighted shared genetic predispositions between celiac disease and autoimmune liver conditions, particularly involving HLA genes.

Diet and Metabolism

Adopting a gluten-free diet, essential for managing celiac disease, can sometimes lead to rapid weight gain or an imbalanced diet, which may increase the risk of metabolic-related liver diseases.

Implications for Patients and Physicians

Monitoring and Prevention

While the absolute risk of chronic liver disease remains low, the findings underscore the importance of regular liver enzyme monitoring for individuals with celiac disease, especially during the early years after diagnosis. Physicians should be vigilant for signs of liver dysfunction, particularly in those with additional risk factors, such as metabolic disorders or autoimmune conditions.

Patient Education

Educating patients about maintaining a balanced gluten-free diet and avoiding excessive alcohol consumption could reduce liver-related risks. Patients with elevated liver enzymes may benefit from closer dietary and metabolic monitoring.

Conclusion

This study highlights a persistent, albeit low, increased risk of chronic liver disease in individuals with celiac disease. The findings emphasize the need for proactive monitoring and preventive measures to mitigate long-term liver-related complications. For patients with celiac disease, understanding these risks and collaborating with healthcare providers can lead to better overall management and long-term health outcomes.

Read more at: thelancet.com

Celiac.com 05/16/2024 - Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition often linked with metabolic syndrome. Lifestyle interventions have been the mainstay of management due to the lack of approved pharmacological treatments. One emerging area of interest is the role of wheat amylase trypsin inhibitors (ATI) in promoting intestinal and extra-intestinal inflammation, including liver fibrosis and insulin resistance.

The study focused on evaluating the impact of an ATI-free diet on metabolic dysfunction-associated steatotic liver disease (MASLD) through a 6-week randomized controlled trial. An ATI-free diet specifically eliminates wheat amylase trypsin inhibitors (ATIs), whereas a gluten-free diet avoids all sources of gluten, which includes ATIs but extends to other grains like barley and rye. The trial involved 45 patients, with 21 following an ATI-free diet and 24 on a balanced diet as per German Nutrition Society recommendations. Key parameters such as controlled attenuation parameter (CAP), body mass index (BMI), homeostatic model assessment of insulin resistance (HOMA-IR), and patient-reported outcomes (PROs) using the CLDQ-NASH questionnaire were assessed.

Key Findings and Implications

1. Significant Improvements: Patients on the ATI-free diet showed notable improvements in BMI, CAP, and HOMA-IR values, indicating better liver health and metabolic parameters compared to the control group.
2. Patient-Reported Outcomes: PROs assessed through the CLDQ-NASH questionnaire indicated better outcomes in the ATI-free diet group, emphasizing overall well-being benefits from the dietary intervention.
3. Implications for MASLD: The study suggests that short-term adoption of an ATI-free diet can lead to meaningful improvements in liver health and metabolic parameters in MASLD patients, offering a potential dietary approach for managing the condition.

In summary, results showed significant improvements in the ATI-free diet group compared to the control group. Patients on the ATI-free diet experienced reduced BMI, CAP, and HOMA-IR values, indicating improved liver health and metabolic parameters. Patient-reported outcomes also showed better outcomes in the ATI-free diet group, highlighting the overall well-being benefits of the dietary intervention.

Relevance to Celiac Disease

While the study primarily focused on MASLD, the findings have implications for individuals with celiac disease:

• Dietary Management: Similar to MASLD, celiac disease involves adverse reactions to gluten. The study's emphasis on the benefits of an ATI-free (gluten-free) diet underscores the importance of dietary management in celiac disease.
• Innovative Solutions: The study highlights the role of dietary interventions in improving liver health and overall well-being. For individuals with celiac disease, exploring gluten-free diets under healthcare guidance may provide valuable insights into managing their condition.
• Future Research: The positive outcomes seen in MASLD patients on an ATI-free diet could inspire further research into dietary approaches for celiac disease management, potentially leading to more tailored and effective interventions.

These findings suggest that short-term adoption of an ATI-free diet can lead to meaningful improvements in liver health, metabolic parameters, and patient-reported outcomes in MASLD patients. Further studies with larger sample sizes and longer durations are needed to validate these findings and explore additional biomarkers of dietary compliance and disease progression.

In conclusion, while directly focusing on MASLD, this study indirectly suggests promising avenues for dietary management in celiac disease, emphasizing the potential benefits of gluten-free diets for individuals with gluten-related conditions.

Read more in Alimentary Pharmacology & Therapeutics
 

Celiac.com 11/22/2023 - A recent study focused on investigating intestinal gluconeogenesis in children with untreated celiac disease. Gluconeogenesis is a process in the small intestine that converts glutamine into glucose, and it plays a crucial role in metabolic control.

Animal studies have suggested that impaired intestinal gluconeogenesis may have long-term effects on metabolic health and be associated with the development of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD).

The Research Team

The research team included Olof Karlson, Henrik Arnell, Audur H. Gudjonsdottir, Daniel Agardh & Åsa Torinsson Naluai. They are variously affiliate with the Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden; the Department of Paediatric Gastroenterology, Hepatology and Nutrition, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden; the Department of Clinical Sciences, Unit of Celiac Disease and Diabetes, Lund University, Malmö, Sweden; and the Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

Quantitative Polymerase Chain Reaction to Measure the Expression of 11 Target Genes

The researchers aimed to examined intestinal gluconeogenesis at the gene expression level in children with untreated celiac disease. They used quantitative polymerase chain reaction (qPCR) to measure the expression of 11 target genes related to intestinal gluconeogenesis in duodenal biopsies collected from 84 children with untreated celiac disease and 58 disease controls. The expression levels were compared to assess any differences.

Impaired Intestinal Gluconeogenesis Process Discovered in Children with Untreated Celiac Disease

The findings revealed that children with untreated celiac disease exhibited significantly lower expression of nine target genes involved in intestinal gluconeogenesis compared to the control group. These genes included FBP1, G6PC, GLS, GPT1, PCK1, PPARGC1A, SLC2A2, SLC5A1, and SLC6A19. However, there was no significant difference in the expression of G6PC3 or GOT1.

The decreased expression of these important genes suggests an impaired intestinal gluconeogenesis process in children with untreated celiac disease. It remains unclear whether this decrease is a consequence of intestinal inflammation, or a shared metabolic pathway associated with other chronic metabolic diseases. However, this impaired intestinal gluconeogenesis may contribute to the increased risk of non-alcoholic fatty liver disease observed in celiac disease patients.

Further research is needed to fully understand the mechanisms underlying these findings and to explore potential interventions or treatments that could alleviate the metabolic consequences of impaired intestinal gluconeogenesis in individuals with celiac disease.

Read more in BMC Medicine volume 20, Article number: 440 (2022)

Celiac.com 06/27/2023 - Some individuals with celiac disease experience liver complications such as elevated liver enzymes, liver cirrhosis, and autoimmune hepatitis. A group of researchers conducted a systematic review with meta-analyses to determine the combined prevalence of celiac disease in patients with different liver conditions. Here's what they found.

The research team included Yoosuf, Shakira MD; Singh, Prashant MD; Khaitan, Ashank MBBS; Strand, Tor A. MD; Ahuja, Vineet MD, DM; and Makharia, Govind K. MD, DM, DNB. They are variously affiliated with the Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India; the Chettinad Hospital and Research Institute, Chennai, Tamilnadu, India; the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA; the Department of Global Public Health, Innlandet Hospital Trust, Lillehammer, Norway.

Medical Databases Searched for Relevant Liver and Celiac Diesase Studies

They searched medical databases for relevant studies up to January 2022. Studies that performed serological tests and/or intestinal biopsy for celiac disease on patients with cryptogenic cirrhosis, all-cause cirrhosis, cryptogenic hypertransaminasemia (elevated liver enzymes), and all-cause hypertransaminasemia were included. The researchers calculated the pooled estimates of seroprevalence (presence of celiac antibodies in the blood) and the rates of biopsy-confirmed celiac disease in these four groups.

Out of the many articles screened, 20 articles were included in the final analysis for cryptogenic cirrhosis, all-cause cirrhosis, and cryptogenic hypertransaminasemia. However, for all-cause hypertransaminasemia, a qualitative review of four studies was conducted due to significant differences in the studies.

Patients with Cryptogenic Cirrhosis ~5% and Cryptogenic Hypertransaminasemia 6%

The results showed that the pooled prevalence of biopsy-confirmed celiac disease in patients with cryptogenic cirrhosis was approximately 5%. For all-cause cirrhosis, the prevalence was less than 1%. In the case of cryptogenic hypertransaminasemia, the pooled prevalence of biopsy-confirmed celiac disease was nearly 6%.

These findings suggest that approximately 1 in 20 patients with cryptogenic cirrhosis or cryptogenic hypertransaminasemia have celiac disease. Therefore, individuals with these liver conditions should be considered high-risk groups for celiac disease and may benefit from screening. Although the prevalence of celiac disease in individuals with all-cause cirrhosis is similar to the general population, it may still be worth conducting celiac screening the, because the liver damage in these cases has the potential for reversal.

Read more in The American Journal of Gastroenterology 118(5):p 820-832, May 2023.

Celiac.com 01/03/2022 - Studies looking at rates of celiac disease in people with autoimmune hepatitis (AIH) have shown wide ranging results.  A team of researchers recently set out to examine the rates of celiac disease in individuals with autoimmune hepatitis.

For their systematic review and meta-analysis the team used two professional librarians to conduct a search of PubMed, EMBASE, Cochrane and Web of Science Core Collection up to 7 February 2020.  Search terms included 'celiac disease', 'celiac', 'transglutaminases', 'gluten', 'gliadin', 'EMA', 'TTG' and 'villous' combined with 'autoimmune', 'hepatitis', 'ANA', 'SMA' and 'LKM'. 

This search yielded 2,419 unique publications. A systematic review based on the PRISMA guidelines resulted in 31 articles eligible for full text review. They found fifteen relevant articles, eight of which they included in their main analysis. The team used a fixed-effect inverse variance-weighted model, and calculated heterogeneity.

The team's main analysis included 567 autoimmune hepatitis patients from eight studies. Twenty three of those patients showed biopsy-verified celiac disease equivalent to Marsh III. The pooled rate of celiac disease in autoimmune hepatitis patients 3.5%, which is more than triple the 1% celiac disease rates in most general populations. 

When also including the fifteen studies on 1,817 people where celiac disease had been diagnosed through positive serology without biopsy, the pooled rate of celiac disease was just under 3%.

The team's results show high rates of celiac disease in people with autoimmune hepatitis compared to the general population. As such, they are recommending that physicians consider celiac disease screening for patients with autoimmune hepatitis.

Read more in Liver International. 2021;44(11):2693-2702. 

The research team included Linnea Haggård; Ida Glimberg; Benjamin Lebwohl; Rajani Sharma; Elizabeth C. Verna; Peter H. R. Green; and Jonas F. Ludvigsson. They are variously affiliated with the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the School of Medical Sciences, Örebro University, Örebro, Sweden; the Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; the Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, NY, USA; the Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; and the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.

Celiac.com 11/08/2021 - Researchers know that non-alcoholic fatty liver disease is strongly associated with metabolic syndrome. But, are rates for non-alcoholic fatty liver disease higher in patients with celiac disease on a gluten-free diet? What about rates of celiac disease in patients with non-alcoholic fatty liver disease?

A team of researchers recently set out to determine risk of non-alcoholic fatty liver disease for people with celiac disease on a gluten-free diet. The research team included M Aggarwal, P Kumar, R Garg, CC Lindenmeyer, J Wakim-Fleming, and A Rubio-Tapia.

For their systemic review and meta-analysis, they included 12 studies involving nearly 5,000 subjects. Five of those studies, totaling 1,268 participants, determined rates of non-alcoholic fatty liver disease in patients with celiac disease, while seven studies on just over 3,700 subjects assessed rates of celiac disease in patients with non-alcoholic fatty liver disease. Their analysis included only studies with fifty or more cases of celiac disease with most participants over 15 years of age. They assessed new diagnoses of serology- and histology-positive celiac disease.

Researchers reported pooled rates of non-alcoholic fatty liver disease of 12.3% in celiac patients before initiating a gluten-free diet, and 21.4% in celiac patients after initiating a gluten-free diet. They saw a significant increase in the odds of celiac patients developing non-alcoholic fatty liver disease after starting a gluten-free diet.

They saw a pooled rate of 5.3% (95% CI, 3.5-8.0; I2 = 76%) and 3.1% (95% CI, 1.7-5.6; I2 = 79%) in patients with non-alcoholic fatty liver disease with serology-positive and histology-positive celiac disease, respectively.

Based on their data, the team concludes that the odds of people with celiac disease developing non-alcoholic fatty liver disease nearly double after they begin a gluten-free diet. The team recommends close monitoring of celiac patients for non-alcoholic fatty liver disease over time. 

Given the long-term metabolic consequences of non-alcoholic fatty liver disease, the team suggests that doctors consider non-alcoholic fatty liver disease screening in celiac patients.

The information was presented at the Annual Meeting of the American College of Gastroenterology, from October 22 to 27, 2021. 

Read more in Gastroenterology Advisor

Celiac.com 07/14/2021 - Prior efforts to determine rates of celiac disease in individuals with autoimmune hepatitis (AIH) have shown highly variable data. To get better data and develop a clearer picture of the issue, a team of researchers recently set out to assess rates of celiac disease in individuals with AIH.

For their study, the team employed two professional librarians to search PubMed, EMBASE, Cochrane and Web of Science Core Collection for entries through February 7th, 2020. Their search turned up nearly 2,500 unique publications that included any of the terms “celiac disease”, “celiac”, “transglutaminases”, “gluten”, “gliadin”, “EMA”, “TTG” and “villous” combined with “autoimmune”, “hepatitis”, “ANA”, “SMA” or “LKM”. 

The team then conducted a systematic review based on the PRISMA guidelines. They found 31 articles eligible for full-text review, 15 of which were deemed relevant. They included eight publications in their main analysis, using a fixed-effect inverse variance-weighted model, and also determining heterogeneity.

Their final analysis included 567 individuals with AIH from eight studies, where they found biopsy-verified celiac disease equivalent to Marsh III in 23 individuals, for a rate of about 4%. The pooled rate of celiac disease in AIH was 3.5%, more than triple the 1% celiac disease rates found in most general populations. When 15 other studies of 1,817 AIH patients were included, where celiac disease had been diagnosed through positive serology without biopsy, the pooled rate of celiac disease was still about 3%. 

This study shows that celiac disease rates are higher in individuals with AIH compared to the general population. The study team recommends that doctors consider celiac screening in patients with AIH.

Read more in Liver International
 

The research team included Linnea Haggård, Ida Glimberg, Benjamin Lebwohl, Rajani Sharma, Elizabeth C Verna, Peter HR Green, and Jonas F. Ludvigsson. They are variously affiliated with the Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden; Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA; the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; the Center for Liver Disease and Transplantation, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, USA; the Division of Digestive and Liver Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA; the Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; and the Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK.

Celiac.com 06/22/2021 - People with celiac disease have a higher risk for developing non-alcoholic fatty liver disease (NAFLD) and other related metabolic disorders, especially if they are not on a gluten-free diet. 

A team of researchers recently set out to explore the prevalence of NAFLD and metabolic-associated fatty liver disease in celiac patients at the time of celiac diagnosis and after 2 years of GFD; and to assess the role of PNPLA3 rs738409 in the development of NAFLD and metabolic-associated fatty liver disease in the celiac population.

Recently, a new category of metabolic-associated fatty liver disease (MAFLD) has been proposed to move beyond the constraints of the NAFLD definition. 

The research team included Antonio Rispo; Nicola Imperatore; Maria Guarino; Raffaella Tortora; Anna Alisi; Valentina Cossiga; Anna Testa; Simona Ricciolino; Andrea Fiorentino; and Filomena Morisco.

They are variously affiliated with the Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy; the Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy; the  Hepatology Unit, AORN A. Cardarelli, Naples, Italy; and the Research Unit of Molecular Genetics and Complex Phenotypes, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

For the study, the team retrospectively enrolled all newly diagnosed celiac patients who underwent clinical, laboratory and ultrasonography investigations, both at diagnosis and at a two year follow-up. They also conducted a PNPLA3 rs738409 genotyping assay.

They found that 65 of 221 newly diagnosed celiac patients, nearly 30%, presented NAFLD upon celiac diagnosis, while 32 of 221 met the criteria for metabolic-associated fatty liver disease. 

There were no major differences between NAFLD and metabolic-associated fatty liver disease, though 3 out of 4 metabolic-associated fatty liver disease patients had higher rates of insulin resistance (IR) compared with 2 out of 5 for NAFLD patients. 

The study shows that the newly established metabolic-associated fatty liver disease definition better describes the metabolic changes common when celiacs adopt a gluten-free diet. 

The new classification may help to spot patients at risk of worse metabolic outcomes, who will likely benefit from a close multidisciplinary approach for their multi-systemic disease.

Keep an eye on celiac.com for more stories on celiac disease and metabolic-associated fatty liver.

Read more in Liver International. 2021;41(4):788-798.
 

Celiac.com 08/12/2020 - The interaction between celiac disease and the liver is complex and not well understood. In some cases, isolated hypertransaminasemia is the only clear sign of celiac disease, while in other cases, liver diseases can occur with isolated tissue transglutaminase antibodies IgA (tTG IgA), but without the histologic markers that would indicate celiac disease.

A team of researchers recently set out to assess the results of tTG IgA testing for chronic liver disease (CLD) or cytolysis, and to seek out biopsy-confirmed celiac disease in patients with existing liver disease.

The research team included Lena Cvetkovic, Gabriel Bernard, Nathanaelle Galette, Pierre-Olivier Hétu, Catherine Vincent, Mickael Bouin, and Amelie Therrien. They are variously affiliated with the Department of Medicine - Division of Gastroenterology, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; the Department of Biochemistry, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; and the Department of Medicine, Division of Hepatology, Centre de recherche du Centre Hospitalier de l'Université de Montréal in Montréal, Québec, Canada.

Their retrospective study used two groups. The first included 444 consecutive patients with no known celiac disease, for whom liver specialists had ordered tTG IgA testing. In this group, the team assessed the incidence of positive tTG and biopsy-confirmed celiac disease. 

The second group included 212 consecutive individuals with positive tTG IgA and subsequent duodenal biopsies. In this group, the team assessed the frequency and clinical features of patients without biopsy-confirmed celiac disease, both with and without liver disease.

Tests conducted on the first patient group by a liver specialist turned up nine first time positive tTG IgA results. However, only six of these patients had biopsy-confirmed celiac disease. The second group included 33 individuals who also had liver disease, though nearly 43% showed no biopsy-confirmed celiac disease, compared with the 16% of patients who did not have liver disease. 

Nearly two-thirds of the patients without biopsy-confirmed celiac disease showed an increase below three times the upper limit of normal of tTG IgA. Cases of chronic liver disease without elevated transaminase levels showed no association with celiac disease.

Testing liver disease patients for celiac disease can be helpful, but large numbers of patients may show positive celiac tests without any histological signs celiac disease.

Read more at J Can Assoc Gastroenterol. 2020 Aug;3(4):185-193.

Celiac.com 10/24/2018 - Although some research has shown a connection between a gluten-free diet, altered macronutrient intake and metabolic syndrome, not much good data exists on the risk of nonalcoholic fatty liver disease in patients with celiac disease who follow a gluten-free diet. A team of researchers recently set out to assess the prevalence and relative risk of nonalcoholic fatty liver disease in celiac patients treated with a gluten-free diet.

The research team included F. Tovoli; G. Negrini; R. Farì; E. Guidetti; C. Faggiano; L. Napoli; L. Bolondi; and A. Granito of the Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.

For many patients with metabolic syndrome, nonalcoholic fatty liver disease is common. To try to get some better information, the researchers devised a case-control study, with prospective enrollment of celiac disease outpatients following a gluten-free diet and control subjects. 

For the study, the team matched patients by age, gender and metabolic risk factors, such as overweight, diabetes mellitus, total cholesterol, and triglycerides, using a 1:1 ratio.  The team diagnosed nonalcoholic fatty liver disease according to the criteria set by the European Association for the Study of the Liver.

In all, they compared 202 celiac disease patients and 202 control subjects. The raw rate of nonalcoholic fatty liver disease was 34.7% and 21.8% in the celiac disease and control group, respectively. Using binary logistic regression, the team demonstrated that those with celiac disease faced an increased risk for nonalcoholic fatty liver disease. 

Meanwhile, the relative risk for nonalcoholic fatty liver disease was substantially higher in non-overweight celiac disease patients. Nearly 35% of celiac disease patients on a gluten-free diet also had nonalcoholic fatty liver disease, that’s a risk three times greater than the general population. 

The team recommends that doctors tailor their celiac treatment approaches to better help celiac disease patients with nonalcoholic fatty liver disease to get proper nutritional intake, which will help to reduce the risk of long-term liver-related events.

Source: Aliment Pharmacol Ther. 2018;48(5):538-546.

Celiac.com 10/23/2017 - What's the relationship between celiac disease and liver histology, serology and treatment response?

Celiac disease is diagnosed on the basis of ESPGHAN criteria, and clinical response to gluten-free diet. Researchers have noted histological abnormalities on liver biopsies in patients with celiac disease, but have rarely described the abnormalities in detail.

A team of researchers recently set out to assess the histological spectrum of 'celiac hepatitis' and to see if a gluten-free diet can reduce such features. The research team included K Majumdar, P Sakhuja, AS Puri, K Gaur, A Haider, and R Gondal. They are variously affiliated with the Department of Pathology, and the Department of Gastroenterology at the G B Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.

Their team analyzed twenty-five patients with concomitant celiac disease and hepatic derangement for clinical profile, laboratory investigations and duodenal and liver biopsy. They then made a histological comparison of pre- and post-GFD duodenal and liver biopsies, where possible.

They found that fifteen patients with celiac disease later developed abnormal liver function tests. They also found that 7 out of 10 patients with liver disease showed tissue positive transglutaminase, while 6 of the 10 had antigliadin antibodies. Eight patients showed serological markers for autoimmune liver disease (AILD). Liver histology ranged from mild reactive hepatitis, chronic hepatitis, and steatosis to cirrhosis.

They found six patients with liver biopsies made after a gluten-free diet. Five of these patients showed a decrease in steatosis, portal and lobular inflammation and fibrosis score.

From these results, they concluded that celiac hepatitis could be a distinct condition, and that patients may present with either celiac disease, or with secondary hepatic derangement. They recommend celiac evaluations for patients with AILD, unexplained transaminasaemia or anemia.

This is one of the few studies to show the range of histological changes to the liver in patients with 'celiac hepatitis'. They note that the adoption of a gluten-free diet in such patients may help to improve symptoms of 'celiac hepatitis'.

Source:

• J Clin Pathol. 2017 Sep 29. pii: jclinpath-2017-204647. doi: 10.1136/jclinpath-2017-204647.