Liver dysfunction in celiac disease

Although the spectrum of liver abnormalities 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 occurrence is a cryptogenic hypertransaminasemia, present in about a half of untreated celiac patients, as an expression of a mild liver impairment characterised by a histological picture of non specific reactive hepatitis (celiac hepatitis) reverting to normal after a few months of gluten withdrawal. In a few cases, a more severe liver injury leading to chronic hepatitis or liver cirrhosis is present. In these patients liver damage can still improve after a gluten-free diet institution. In addition, a close association between celiac disease and autoimmune liver disorders has been largely demonstrated. Indeed, 3%-7% of patients with primary biliary cirrhosis, 3%-6% with autoimmune hepatitis and 2-3% with primary sclerosing cholangitis are affected by celiac disease. Autoimmune liver dysfunction, found in celiac disease, does not usually improve after 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 duration of gluten exposure may determine the severity and the pattern of liver injury.