About one person or so in every hundred has celiac disease

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Celiac Disease and Liver Disorders

 

http://www.celiac.com/articles/21501/1/Celiac-Disease-and-Liver-Disorders/Page1.html

 

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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