Hepatic Lesions in Adult Coeliac Disease

Abstract

In the period 1970 to 1987, 171 patients with small-intestinal mucosal atrophy have been hospitalized in our department. Of these, 132 patients fulfilled the diagnostic criteria of coeliac disease on the basis of histologic findings and clinical improvement on a gluten-free diet. Aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), and alkaline phosphatase (ALP) were chosen as markers of hepatic involvement. Elevation above the normal range in one or more of these tests was seen in 62 patients (47.0%, group I). In 70 patients (53.0%, group II) of similar age the levels of these variables were normal. In group I, 14 (10.6%) patients had an elevation of ALP only, leaving 48 (36.4%) patients with pathologic values for one or both transaminases. In group I, 32 patients had their ASAT, ALAT, and ALP reexamined after at least 6 months of gluten-free diet. Among the patients with increased values of one or both transaminases 18 patients were tested before and at least 6 months after start of gluten-free diet. The variables were significantly reduced in all patients. Liver biopsies were performed in 37 patients, and findings were normal in 5. In 25 patients the changes were classified as non-specific. Chronic active hepatitis was demonstrated in five patients. In one of these patients primary sclerosing cholangitis and ulcerative colitis were also diagnosed. Concomitant malignant disease was found in 22 patients, of whom 16 had malignant lymphoma. Malignant disease was seen more often in group I than group II (p less than 0.01). In conclusion, liver lesions were found in a great proportion of the patients with coeliac disease.(ABSTRACT TRUNCATED AT 250 WORDS)

The liver in celiac disease

“…All the patients with nonspecific changes in the liver histology and a follow-up liver biopsy normalized the histological changes after adherence to a GFD. 6,23,27 This reversible, glutenrelated liver damage has been called celiac hepatitis. 28 An alternative etiology for liver injury should be explored in those patients with persistent hypertransaminasemia despite gluten exclusion.…”

“…In patients with CD and liver injury for whom a liver biopsy has been performed, histological changes are frequent (66%) but generally mild and nonspecific. 6,8,23,27 The abnormalities include periportal inflammation, bile duct obstruction, an increased number of Kupffer cells, mononuclear infiltration in the parenchyma, steatosis, and mild fibrosis. 6,8,23,24 Extensive fibrosis and cirrhosis have also been reported 21,22 ( Fig.…”

“…The isolated elevation of alkaline phosphatase (ALP; 4%-20%) is less common and may reflect secondary hyperparathyroidism (bone-specific isoform). 7,23 The presence of hypoalbuminemia, a prolonged prothrombin time, and especially hyperbilirubinemia in CD may suggest cirrhosis. 21,22 Hypoalbuminemia and a prolonged prothrombin time, however, may be indirect markers of severe malabsorption.…”

“…A GFD leads to normalization of serum transaminases in 75% to 95% of patients with CD, usually within a year of good adherence to the diet 7,16,23 (Table 2). All the patients with nonspecific changes in the liver histology and a follow-up liver biopsy normalized the histological changes after adherence to a GFD.…”

“…The reversible nature of severe histological changes in the liver of patients with CD is controversial, but the reversal of severe fibrosis in a liver biopsy after gluten exclusion has been reported. 21,23 Autoimmune Liver Disorders Associated with Celiac Disease…”