In this study period, the charts from 245 untreated CD patients (196 women and 49 men, age range 15–80 years) fulfilled criteria for analysis. Histological assessment according to the Marsh–Oberhuber classification and the new proposed classification showed type 3 a/c (grade B1/B2 of the new classification) in all but one patient, classified as type 2 (grade A of the new classification). Aminotransferases normal values for our laboratory were: AST, 0–38 U/L, ALT, 0–34 U/L.
Overall, 43/245 (17.5%) patients had elevated values of one or both aminotransferases, distributed as follows: 1 patient (2%) had elevation of AST, 15 patients (35%) had elevation of ALT and 27 (63%) had elevation of both enzymes. In this group, basal AST values were 70 ± 11 U/L and ALT values were 82 ± 12 U/L. Aminotransferase 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.
No significant correlation was found between age and AST (r = 0.12, P = 0.53) or ALT (r = −0.10, P = 0.52) values. All these patients were also screened for autoimmune or metabolic disorders and alcohol intake, drug use or exposure to the potential hepatic toxins were excluded as completely as possible.
Associated disorders/conditions in these 43 patients are shown in Table 1. Patients with HCV infection, non-alcoholic steatohepatitis (NASH) and primary biliary cirrhosis (PBC) all had the diagnosis confirmed by liver biopsy (that showed chronic active hepatitis in one and cirrhosis in two HCV-infected patients). Abdominal ultrasound showed the presence of mild to moderate hepatic steatosis in all the 43 CD patients with abnormal aminotransferase levels.
After 1 year of GFD, AST values were 28 ± 4 U/L and ALT values were 32 ± 4 U/L (P < 0.0001 compared to basal for both values) (Fig. 1). Normalization was evident in all but the four patients with HCV infection or primary biliary cirrhosis.
Liver International. 2013;33(7):1128-1131. © 2013 Blackwell Publishing