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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 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.