The liver in coeliac disease

Pollock, D. J.

doi:10.1111/j.1365-2559.1977.tb01681.x

Cited by 49 publications

(29 citation statements)

References 24 publications

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“…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.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…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.…”

Section: Managementmentioning

confidence: 99%

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The liver in celiac disease

2007

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Celiac disease is a common (1% prevalence) chronic immune-mediated disorder of the small intestine induced by dietary wheat, barley, and rye. Several hepatic disorders have been described in association with celiac disease. Isolated hypertransaminasemia with nonspecific histologic changes in a liver biopsy is the commonest hepatic presentation of celiac disease. A gluten-free diet normalizes liver enzymes and histologic changes in most patients. Moreover, celiac disease can coexist with autoimmune liver disorders such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Celiac disease has increasingly been reported with a variety of other liver diseases. Thus, the hepatologist needs to consider celiac disease in the differential of abnormal liver blood tests and to be aware of the clinical implications of this frequent disease in patients with liver disorders. The possible mechanisms of liver injury and those common factors that explain the association of celiac disease with liver disorders are discussed. The aims of this article are (1) to review the spectrum and pathogenesis of liver injury related to celiac disease and (2) to provide direction to those caring for patients with chronic liver diseases regarding the detection and effective treatment of celiac disease. (HEPATOLOGY 2007;46:1650-1658

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Section: Clinical Manifestationsmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

The liver in celiac disease

2007

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“…The occurrence of liver impairment in CD is well established and must be regarded as one of the manifold extraintestinal presentations of gluten-sensitive enteropathy [18][19][20][21][22]. The pathology of the liver has been explored in 19 patients with severe malabsorption due to CD with different grades of liver damage found, including mild hepatitis, liver fibrosis, and cirrhosis [23]. Two important moments have significantly improved our knowledge about the significance of liver injury in CD.…”

Section: Introductionmentioning

confidence: 99%

Pathogenesis and Clinical Significance of Liver Injury in Celiac Disease

Volta

2008

Clinic Rev Allerg Immunol

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Abnormalities of liver function are one of the manifold extraintestinal manifestations of celiac disease. Although the spectrum of liver manifestations associated with celiac disease is particularly wide, two main forms of liver damage namely, cryptogenic and autoimmune, appear to be strictly related to gluten-sensitive enteropathy. The most frequent finding is represented by a cryptogenic hypertransaminasemia, observed in about a half of untreated celiac patients, as an expression of a mild liver dysfunction with a histological picture of nonspecific reactive hepatitis (celiac hepatitis) reverting to normal after 6-12 months of a strict gluten-free diet. In a few cases, when celiac disease is diagnosed, a more severe liver injury, characterized by a cryptogenic chronic hepatitis or liver cirrhosis, is present. In these patients, liver damage can still improve after a gluten-free diet institution. Moreover, a close association between celiac disease and autoimmune liver disorders has been widely demonstrated. Indeed, celiac disease has been found in 3-7% of patients with primary biliary cirrhosis, in 3-6% with autoimmune hepatitis, and in 2-3% with primary sclerosing cholangitis. Differently from cryptogenic liver injury, autoimmune liver dysfunction, found in celiac disease, does not usually improve after a gluten-free diet. Presently, it is difficult to establish if the two main kinds of liver injury found in celiac disease (cryptogenic and autoimmune) are discrete entities with a different pathogenesis or if they are an expression of the same disorder where genetic factors and the duration of gluten exposure may determine the severity and the pattern of liver injury.

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“…Hepatic injury is signaled by elevated serum transaminases [aspartate-and alanineaminotransferase (AST/ALT)] and occurs in as many as 50% of untreated CD patients, the condition being reverted upon treatment with a gluten-free diet (GFD) [10][11][12][13][14][15]. Isolated hypertransaminasemia may be the only sign of early-detected CD [16][17][18][19], being the expression of either nonspecific histological changes of the liver or more severe liver disease; in fact only a minority of these patients may harbor autoimmune liver disorders, like primary biliary cirrhosis [20][21][22][23], primary sclerosing cholangitis [24], and autoimmune hepatitis [25][26][27][28], whose progression is not apparently affected by GFD [10,29].…”

Section: Introductionmentioning

confidence: 99%