Factors that contribute to hypertransaminasemia in patients with celiac disease or functional gastrointestinal syndromes
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Published on: December 15, 2011
Barbara Zanini1, Roberta Baschè1, Alice Ferraresi1
1Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
Insights
In celiac disease patients, elevated liver enzymes (hypertransaminasemia) are linked to malabsorption and intestinal damage, not BMI. A gluten-free diet improves liver enzyme levels.
Area of Science:
- Gastroenterology
- Hepatology
- Internal Medicine
Background:
- Hypertransaminasemia (elevated liver enzymes) occurs through various pathways in celiac disease.
- Risk factors specifically linked to celiac disease remain unclear.
Purpose of the Study:
- To investigate the factors associated with hypertransaminasemia in celiac disease patients.
- To compare these factors with those in patients experiencing functional syndromes.
Main Methods:
- Analysis of data from 683 celiac disease patients and 304 patients with functional syndromes.
- Assessment of hypertransaminasemia in relation to malabsorption, diarrhea, mucosal lesion severity, body mass index (BMI), and tissue-transglutaminase antibodies (tTG).
Main Results:
- Hypertransaminasemia was found in 20% of celiac disease patients, associated with malabsorption and increased mucosal lesion severity.
- In controls, hypertransaminasemia correlated with BMI.
- Gluten-free diet reduced aspartate aminotransferase (AST) levels in celiac disease patients, correlating with BMI.
Conclusions:
- Celiac disease patients exhibit a higher prevalence of hypertransaminasemia compared to controls.
- Hypertransaminasemia in celiac disease is associated with duodenal lesion severity and malabsorption, independent of BMI.
- Dietary changes in celiac disease patients impact liver enzyme levels and their relationship with BMI.
Background & Aims:
Transaminasemia develops via different pathways in patients with celiac disease; no information is available on risk factors specifically attributable to celiac disease.
Methods:
We analyzed data collected from consecutive patients referred from January 1997 through December 2009 to the celiac disease clinic at the Spedali Civili of Brescia, Italy. We assessed the factors affecting hypertransaminasemia in 683 patients with celiac disease (based on serologic and biopsy analysis, cohort A; 34 ± 14 years of age) and 304 with functional syndromes (cohort B; 37 ± 13 years of age).
Results:
Hypertransaminasemia was detected in 138 patients in cohort A (20%). It was associated with malabsorption (odds ratio [OR], 2.22; P = .004), diarrhea (OR, 1.72; P = .005), and increasing severity of mucosal lesion (Marsh-Oberhuber class; OR, 1.46; P = .001) but not with body mass index (BMI) or the serum level of tissue-transglutaminase antibodies (tTG). Hypertransaminasemia was detected in 22 patients in cohort B (7%) and was associated with the World Health Organization's BMI categories (OR, 7.9; P < .001). In subsets of patients studied with the same analytical method (313 of cohort A and 188 of cohort B), the level of tTG was significantly higher in cohort A at baseline (25.2 ± 16.9 U/L aspartate aminotransferase [AST]) than in cohort B (20.6 ± 9.9 U/L AST, P < .0001) and was related to BMI in cohort B (P = .0012) but not cohort A. When patients were placed on gluten-free diets, the levels of AST decreased from 25.2 ± 16.9 U/L to 19.9 ± 6.6 U/L (P < .0001), independently of the changes of duodenal histology and tTG and correlated with BMI (P = .0007); the prevalence of hypertransaminasemia decreased from 13% to 4%.
Conclusions:
Patients with celiac disease have a higher prevalence of hypertransaminasemia than controls (patients with functional syndromes). Hypertransaminasemia is related to the severity of the duodenal lesion and malabsorption but not BMI. By contrast, there was a positive correlation between the levels of AST and BMI in controls; this relationship was restored when patients with celiac disease were placed on gluten-free diets.
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