Prevalence and Causes of Abnormal Liver Function in Patients With Coeliac Disease

Giovanni Casella; Elisabetta Antonelli; Camillo Di Bella; Vincenzo Villanacci; Lucia Fanini; Vittorio Baldini; Gabrio Bassotti


Liver International. 2013;33(7):1128-1131. 

In This Article

Abstract and Introduction


Background & Aims: Coeliac disease patients frequently display mild elevation of liver enzymes and this abnormality usually normalizes after gluten-free diet. To investigate the cause and prevalence of altered liver function tests in coeliac patients, basally and after 1 year of gluten-free diet.
Patients and methods: Data from 245 untreated CD patients (196 women and 49 men, age range 15–80 years) were retrospectively analysed and the liver function tests before and after diet, as well as associated liver pathologies, were assessed.
Results: Overall, 43/245 (17.5%) patients had elevated values of one or both aminotransferases; the elevation was mild (<5 times the upper reference limit) in 41 (95%) and marked (>10 times the upper reference limit) in the remaining 2 (5%) patients. After 1 year of gluten-free diet, aminotransferase levels normalized in all but four patients with HCV infection or primary biliary cirrhosis.
Conclusions: In coeliac patients, hypertransaminaseaemia at diagnosis and the lack of normalization of liver enzymes after 12 months of diet suggest coexisting liver disease. In such instance, further evaluation is recommended to exclude the liver disease. Early recognition and treatment of coeliac disease in patients affected by liver disease are important to improve the liver function and prevent complications.


Coeliac disease (CD) is an immune mediated enteropathy triggered by gluten ingestion (wheat, rye, and barley) in genetically susceptible subjects that affects more than 1% of the general population.[1] The clinical picture can feature intestinal symptoms (mainly involving the small intestine), extraintestinal symptoms (with involvement of bones, skin and nervous system), or appear as a clinically silent disease, detected in individuals who are asymptomatic as part of the screening of populations at increased risk for CD.[2,3]

However, CD may also affect the liver[4–7] and be associated with autoimmune hepatitis.[8,9]

Of interest, CD is diagnosed in as many as 9% patients with cryptogenic hypertransaminaseaemia,[4,10,11] and a mild elevation of aminotransferase levels is common in untreated CD, occurring in approximately 40% of adults and in 50% of coeliac children,[1,2] with the common feature being aminotransferase normalization in 95% patients within the first year after gluten-free diet (GFD).[11]

Here, we report the prevalence and the cause of altered liver function tests at diagnosis and after 1 year of GFD in a series of adult coeliac patients.