Gluten May Trigger Liver Failure Related to Celiac Disease

April 11, 2002

NEW YORK (Medscape Wire) Apr 12 - Several cases of severe liver disease described in the April issue of Gastroenterology are apparently related to celiac disease, as they regressed when patients were placed on a gluten-free diet.

"The possible presence of celiac disease should be investigated in patients with severe liver disease," write Katri Kaukinen, from Tampere University Hospital in Finland, and colleagues. "Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered."

Of the 4 patients with severe liver disease and celiac disease in the study, 1 patient had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Although liver transplantation was imminent in 3 of these patients, a gluten-free diet improved hepatic function in all 4 patients. In 185 adults with previous liver transplantation, 8 patients (4.3%) had celiac disease, including 6 diagnosed preoperatively and 2 detected on screening using serum immunoglobulin A endomysial and tissue transglutaminase antibodies. Only 1 patient had maintained a long-term, strict gluten-free diet.

"Not all of our patients with severe liver failure and celiac disease had apparent symptoms compatible with celiac disease, suggesting that the celiac disease-related liver involvement was not necessarily a complication of malabsorption," the authors write. "Rather, it may well be a gluten-dependent immunologically induced extraintestinal manifestation of celiac disease."

Gastroenterology. 2002;122(4):881-888

Reviewed by Gary D. Vogin, MD

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