From the Guidelines
Yes, celiac disease can increase liver enzymes, as evidenced by studies showing that up to 40% of adults and 54% of children with celiac disease have elevated transaminases at the time of diagnosis 1. This occurs because the autoimmune reaction triggered by gluten consumption in celiac patients can affect the liver, leading to elevated liver enzymes such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase). The liver abnormalities in celiac disease can range from asymptomatic enzyme elevations to more serious conditions like autoimmune hepatitis or primary biliary cholangitis in some cases. Key points to consider include:
- The mechanism involves increased intestinal permeability allowing toxins and antigens to reach the liver via the portal circulation, triggering inflammation.
- Malnutrition resulting from malabsorption in untreated celiac disease can contribute to liver dysfunction.
- Patients with unexplained elevated liver enzymes should consider celiac disease as a potential cause, especially if they have other symptoms like chronic diarrhea, weight loss, fatigue, or anemia.
- Regular monitoring of liver function is recommended for celiac patients, particularly those newly diagnosed or struggling with dietary compliance.
- A gluten-free diet is recommended for patients with celiac disease and NAFLD/NASH to improve liver enzymes and histology, and to prevent progression to cirrhosis, in addition to improving intestinal pathology 1. Additionally, recent guidelines suggest that patients with celiac disease should be assessed for metabolic features, such as glucose, lipid status serum biomarkers, and serum liver enzymes over time, according to age and risk factors, as per the general population 1.
From the Research
Celiac Disease and Liver Enzymes
- Celiac disease has been associated with elevated liver enzymes, particularly aminotransferases, in various studies 2, 3, 4, 5.
- The mechanisms by which liver damage occurs in celiac disease are not fully understood, but intestinal permeability and autoimmunity may play a role 2, 5.
- Patients with celiac disease may present with asymptomatic elevations of liver enzyme levels, nonspecific hepatitis, nonalcoholic fatty liver disease, and autoimmune and cholestatic liver disease 3, 4.
- A gluten-free diet has been shown to normalize liver enzymes and improve histologic changes in most patients with celiac disease and elevated liver enzymes 2, 3, 4, 5.
- Celiac disease may coexist with other chronic liver disorders, such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis, and patients with these conditions should be screened for celiac disease 4, 6.
- The literature suggests that patients with celiac disease should have liver enzymes routinely checked, and those with abnormal liver enzymes should be treated with a strict gluten-free diet 2, 3, 4, 5.