Pathogenesis and Clinical Significance of Liver Injury in Celiac Disease

Volta, Umberto

doi:10.1007/s12016-008-8086-x

Cited by 67 publications

(92 citation statements)

References 95 publications

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“…Due to the estimated high prevalence of CD in patients with cirrhosis that is higher than in the general population [8,16,29,30] , and the potential reversibility of liver dysfunction on a gluten free diet, we recommend prompt consideration and exclusion of SB mucosal diseases and CD (by using a combination of laboratory, clinical, pathologic and genetic examinations, and response to a gluten free diet), when shortened villi, reversal of villus to crypt ratio or villus atrophy are seen in patients with cirrhosis.…”

Section: Discussionmentioning

confidence: 99%

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Wakim-Fleming¹,

Zein²,

Bennett³

et al. 2008

WJG

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INTRODUCTIONStudies of small bowel (SB) mucosa in cirrhosis and portal hypertension report a diverse spectrum of histological abnormalities [1][2][3][4][5] . These include increased capillary angiogenesis, mucosal edema, decreased villus to crypt ratio, villus atrophy and decreased total absorptive surface. Villus abnormalities resemble the abnormalities of coeliac disease (CD) and this may affect the interpretation of small bowel biopsy, and lead to confusion when CD is to be excluded in patients with cirrhosis and portal hypertension.The diagnosis of CD is increasingly considered and work up recommended during the evaluation of abnormal liver enzymes [6][7] . This is in part due to the heightened awareness of the association of CD with a variety of liver disorders. Most commonly described associated liver disorders include autoimmune hepatitis, primary biliary cirrhosis, non-alcoholic fatty liver disease, unexplained abnormal liver tests and cirrhosis [8][9][10][11][12][13][14][15] . The mechanisms of this association are not clear and the prevalence of CD in patients with liver disease is variable depending on the associated liver disease. For example, while CD affects 1% of the general population, one study reports that about 4% of 185 cirrhotic patients who had undergone liver transplantation were found to have CD, and 3 of 4 pa- Abstract AIM: To study the small bowel (SB) mucosa on biopsy in cirrhotic patients with portal hypertension and in non-cirrhotic controls and grade findings according to the Marsh criteria. METHODS: We prospectively enrolled 51 consecutive patients undergoing an upper endoscopy for their routine medical care. Twenty five patients with cirrhosis and portal hypertension were compared to 26 controls. We obtained coeliac serology and multiple upper small bowel biopsies on all 51 patients. A GI pathologist interpreted biopsies and graded findings according to the Marsh criteria. We assessed equivalence in Marsh grade between cirrhotic and non-cirrhotic controls using the Mann-Whitney test for equivalence. RESULTS: Gender, ethnicity and age were similar between both groups. Marsh grades were equivalent between the groups. Grade of 0 was present in 96% and grade of 1 was present in 4% of both groups and there was no villus atrophy or decrease in villus/crypt ratio in patients with portal hypertension. CONCLUSION: This study provides evidence for the lack of villus atrophy in patients with cirrhosis and portal hypertension, and supports the continuous reliance on the Marsh criteria when the diagnosis www.wjgnet.comWakim-Fleming J et al . Cirrhosis with portal hypertension does not cause atrophy of the small bowel mucosa 6371

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Section: Discussionmentioning

confidence: 99%

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Wakim-Fleming¹,

Zein²,

Bennett³

et al. 2008

WJG

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“…W jej przebiegu obserwuje się podwyższoną aktywność AlAT i AspAT oraz prawidłową aktywność fosfatazy alkalicznej, GGTP oraz prawidłowe stężenie bilirubiny. Aktywność transaminaz jest zazwyczaj podwyższona 2-3-krotnie, rzadko więcej niż 10-krotnie, najczęściej AlAT bardziej niż AspAT [5,6]. W biopunktatach wątroby stwierdza się reaktywne, niespecyficzne zmiany zapalne w postaci łagodnego zapalenia okołowrotnego z rozrostem komórek Kupffera, naciekami z komórek jednojądrzastych, rzadko łagod-nym stłuszczeniem wątroby lub włóknieniem [7].…”

Section: Przegląd Piśmiennictwa I Dyskusjaunclassified

“…U większości z nich nieprawidłową aktywność enzymów wątrobo-wych wykrywa się przypadkowo, diagnozując pacjentów z powodu objawów sugerujących występowanie zespołu złego wchłaniania, takich jak niedokrwistość hipochromiczna słabo reagująca na suplementację doustną preparatami żelaza, osteoporoza, poronienia samoistne, hipoplazja szkliwa zębowego, aftowe zapalenie jamy ustnej, opryszczkowate zapalenie skóry czy niskorosłość [5]. Łagodne uszkodzenie funkcji wątroby może być jednak jedynym objawem celiakii.…”

Section: Przegląd Piśmiennictwa I Dyskusjaunclassified

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

Szaflarska-Popławska¹

2011

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“…El efecto de una dieta libre de gluten en estas situaciones es controversial (11,18). Debido a que existe una falta de información sobre anomalías hepáticas relacionadas con la enfermedad celíaca, el presente estudio intenta describir el comportamiento de las transaminasas en la enfermedad celíaca, con el fin de identificar los factores asociados las tasas de alanina aminotransferasa (ALT) que se elevan por encima del tercil superior y de comparar las tasas del suero antes y después de una dieta libre de gluten.…”

Section: Introductionunclassified

El efecto de la dieta libre de gluten en la alanina- aminotransferasa (ALT) en pacientes celíacos

Hatanaka

Silva

Dantas-Corrêa

et al. 2016

Rev. Colomb. Gastroenterol.

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El efecto de la dieta libre de gluten en la alaninaaminotransferasa (ALT) en pacientes celíacosThe effect of a gluten-free diet on alanine aminotransferase (ALT) in celiac patients ResumenIntroducción: la enfermedad celíaca es una enfermedad autoinmune provocada por la ingestión de gluten que afecta aproximadamente al 0,5%-1% de la población mundial. Las señales extraintestinales incluyen elevados niveles de alanina-aminotransferasa (ALT). Objetivo: evaluar los efectos de una dieta libre de gluten en los niveles ALT en pacientes con enfermedad celíaca. Métodos: este estudio transversal se llevó a cabo en la clínica ambulatoria de gastroenterología de un hospital universitario. Resultados: se incluyeron veintiséis pacientes con enfermedad celíaca con edad de 34,1 ± 11,4 años; 15,4% fueron hombres. Los sujetos del estudio tenían un nivel promedio de ALT de 54,6 ± 36,3 (mediana 40,5) U/L. Hubo una mayor proporción de individuos con hepatitis B en el grupo con ALT ≥50 U/L en comparación con sujetos con ALT <50 U/L. Entre los pacientes evaluados después del tratamiento con dieta libre de gluten se observó una reducción significativa de los valores de ALT (36,0 versus 31,0 U/l; p= 0,008). Conclusión: el treinta y cinco por ciento de los pacientes con enfermedad celíaca tenía ALT por encima del tercil superior. Se encontraron niveles más altos de ALT en pacientes con hepatitis viral B y en aquéllos que no se adhirieron a la dieta. Hubo una reducción de aminotransferasas como resultado de una dieta libre de gluten. Palabras claveTransaminasas, enfermedad celíaca, alanina-transaminasa, aminotransferasas aspartato, dieta, libre de gluten. AbstractIntroduction: Celiac disease is an autoimmune disease triggered by ingestion of gluten. It affects approximately 0.5% to 1% of the world population. Extra intestinal manifestations include elevated alanine aminotransferase (ALT) levels. Objective: The objective of this study was to evaluate the effects of a gluten-free diet on ALT levels in patients with celiac disease. Methods: This cross-sectional study was conducted in the gastroenterology outpatient clinic of a university hospital. Results: Twenty-six patients with celiac disease were included. Average patient age was 34.1 ± 11.4 years, and 15.4% of the patients were men. Study subjects had a mean ALT level of 54.6 ± 36.3 U/L (median 40.5). There was a higher proportion of individuals with hepatitis B in the group with ALT ≥ 50 U/L than in the group of subjects with ALT < 50 U/L. Among patients tested after treatment with a gluten-free diet, we observed a significant reduction in ALT values (36.0 vs. 31.0 U/L; P = 0.008). Conclusion: Thirty-five percent of celiac disease patients had ALT levels above the upper tertile. Higher ALT levels were found in patients with viral hepatitis B and in those who do not adhere to the diet. There was a reduction of aminotransferases with a gluten-free diet.

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Pathogenesis and Clinical Significance of Liver Injury in Celiac Disease

Cited by 67 publications

References 95 publications

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

Histological abnormalities of the small bowel mucosa in cirrhosis and portal hypertension

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

El efecto de la dieta libre de gluten en la alanina- aminotransferasa (ALT) en pacientes celíacos

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