Liver injury in coeliac disease – own study and review of the literature

Introduction : Abnormalities of liver function are one of the main extraintestinal manifestations of coeliac disease.

Aim: To investigate the prevalence of liver diseases in children, teenagers and young adults in our own study and to review the literature regarding liver abnormalities in patients with coeliac disease.

Material and methods: All patients with coeliac disease recognised from January 2005 to December 2009, in whom aminotransferase activity was assessed, were retrospectively enrolled. Alanine (ALT) and aspartate (AST) transaminase activity were determined at coeliac disease diagnosis and after 12 months of a gluten-free diet. Causes of raised activity of serum transaminase after dietary treatment were analysed.

Results : Coeliac disease was recognised in 71 children, teenagers and young adults aged from 2 years to 27 years (mean 11.48 years), including 49 females and 22 males. Elevation of ALT and/or AST at coeliac disease diagnosis was observed in 29 patients (40.85%), including elevation of ALT activity from 34 U/l to 162 U/l (mean 56.5 U/l) in 26 patients (36.6%) and elevation of AST activity from 32 U/l to 164 U/l (mean 51.8 U/l) in 25 patients (35.2%). In a group of 29 patients with hypertransaminasaemia at coeliac disease diagnosis in 22 patients (75.9%) transaminases returned to normal within 12 months of gluten withdrawal. In a group of 7 patients without transaminase normalisation, in 1 child colitis ulcerosa and primary sclerosing cholangitis were recognised, in 1 child with type 1 diabetes mellitus autoimmune hepatitis was diagnosed and 3 other patients showed poor compliance with a gluten-free diet. In 2 patients without a known cause of mild increase in transaminase activity (33, 36 U/L) after 12 months of a strict gluten-free diet liver enzymes reverted to normal within more than 12 months of a gluten-free diet and were still lower than the upper normal limit during follow-up.

Conclusions:

1. In all patients with coeliac disease at diagnosis transaminase activity should be routinely checked.

2. In patients with hypertransaminasaemia at coeliac disease diagnosis liver enzymes should be re-evaluated on a gluten-free diet.

3. The persistently elevated serum activity of transaminases after at least 6-12 months of a gluten-free diet must be regarded as evidence of poor compliance with the diet or of a coexistent liver disease.