Prevalence of Celiac Disease in Patients With Liver Diseases: A Systematic Review and Meta-Analyses

Abstract

INTRODUCTION: A subset of patients with celiac disease (CeD) has liver involvement in the form of hypertransaminasemia, liver cirrhosis, and autoimmune hepatitis. We conducted a systematic review with meta-analyses to determine the pooled prevalence of CeD in patients with cryptogenic cirrhosis, all-cause cirrhosis, cryptogenic hypertransaminasemia, and all-cause hypertransaminasemia. METHODS:We searched PubMed and EMBASE up to January 2022. Cross-sectional, case-control, and prospective cohort studies performing serological tests and/or intestinal biopsy for CeD on patients with cryptogenic cirrhosis, all-cause cirrhosis, cryptogenic hypertransaminasemia, and all-cause hypertransaminasemia were included to calculate pooled estimates of seroprevalence and the prevalence of biopsy-confirmed CeD in these 4 groups. RESULTS:Of 6,871 articles screened, 20 articles were included finally in 3 meta-analyses for cryptogenic cirrhosis, all-cause cirrhosis, and cryptogenic hypertransaminasemia. For the all-cause hypertransaminasemia group, a qualitative review of 4 studies was conducted instead of a metaanalysis due to significant differences in studies. The pooled prevalence (95% confidence interval) of biopsy-confirmed CeD in cryptogenic cirrhosis was 4.6% (2.2%-7.5%) while the pooled prevalence of biopsy-confirmed CeD in all-cause cirrhosis was 0.8% (0%-3.4%). The pooled prevalence of biopsyconfirmed CeD in cryptogenic hypertransaminasemia was 5.7% (3.2%-8.8%).DISCUSSION:Nearly 1 in 20 patients each with cryptogenic cirrhosis and cryptogenic hypertransaminasemia have CeD; hence, they should both be considered high-risk groups for CeD. While the prevalence of CeD in those with all-cause cirrhosis is similar to that in general population, it may be worth screening them for CeD because liver pathology has the potential for reversal in them.

The Liver in Celiac Disease: A Strong 2-Way Talk!

“…Yoosuf et al (1) confirmed that CD is associated with cryptogenic cirrhosis finding a pooled prevalence of CD of 4.6% in patients with cryptogenic cirrhosis. CD was found in 0.8% of cases of cirrhosis from any cause, which mirrors the population prevalence of CD (1).…”

“…CD was also identified in unexplained hypertransaminasemia in 5.7% of patients (1). Numerous diseases were ruled out before labeling the patients as unexplained (cryptogenic) hypertransaminasemia.…”

“…Testing may be even more relevant for women because in patients with "cryptogenic" hypertransaminasemia, CD was twice as common in female as in male patients: 7.7% vs 3.6% (1). The study by Yoosuf concludes with a startling clinical message that 1 in 20 patients with cryptogenic cirrhosis or elevated liver tests may have CD (1). Regardless of the exact estimate, we agree that case finding for CD should be strongly considered in patients with unexplained cirrhosis or hypertransaminasemia.…”

“…The American College of Gastroenterology guidelines recommend checking alanine aminotransferase at diagnosis of CD (8). These numbers often normalize or improve on a GFD, as indicated by Yoosuf et al (1). They showed a normalization rate of 97.5% in a sample of 40 patients.…”

“…Celiac disease (CD) is a notorious clinical chameleon with a wide spectrum of extraintestinal manifestations in addition to the classic malabsorptive symptoms. A new systematic review and meta-analysis by Yoosuf et al (1) covers the important area of liver and CD. This study approaches this overlap by examining patients who have cirrhosis or liver test abnormalities, in the form of hypertransaminasemia, to uncover patients with CD.…”