Changing Epidemiology of Liver Involvement in Children With Celiac Disease
Elisa Benelli1, Samuele Naviglio2, Luigina De Leo2
1Department of Medicine, Surgery, and Health Sciences, University of Trieste.
Insights
Liver involvement in children with celiac disease (CD) is less common than previously thought, with younger age being the primary risk factor. Most cases resolve with a gluten-free diet, and associated autoimmune liver disease is rare.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Celiac Disease Research
Background:
- Liver involvement, including elevated transaminases and autoimmune liver disease, is a known complication in children with celiac disease (CD).
- Previous studies reported a higher prevalence of liver involvement at diagnosis in pediatric CD patients.
Purpose of the Study:
- To determine the prevalence, clinical course, and risk factors for liver involvement in a large cohort of children diagnosed with celiac disease.
- To assess the impact of a gluten-free diet on liver enzyme levels in pediatric CD patients with liver involvement.
Main Methods:
- A cohort of 806 children (age 0-18) diagnosed with CD between March 2010 and April 2016 were analyzed.
- Liver involvement was defined as elevated alanine transaminase (ALT) levels (>40 U/L).
- Patients with elevated ALT were re-evaluated after at least 12 months on a gluten-free diet.
Main Results:
- Of 700 patients with available ALT levels, 3.9% (27 patients) exhibited hypertransaminasemia (HTS).
- Younger age (≤4.27 years) was identified as the sole significant risk factor for liver involvement (OR 3.73).
- Following a gluten-free diet, ALT levels normalized in all but three patients; one was diagnosed with sclerosing cholangitis.
Conclusions:
- Liver involvement in pediatric celiac disease appears less frequent than previously reported, potentially due to evolving CD epidemiology.
- Younger age is the primary identified risk factor for liver involvement in this cohort.
- Associated autoimmune liver disease is uncommon, and liver involvement typically resolves with dietary management.
Objectives:
Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15%-57%, autoimmune liver disease 1%-2%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD.
Methods:
Children (age 0-18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet.
Results:
CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9%), and were elevated in 27 (3.9%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49-80 U/L) and 67 U/L (interquartile range 53-85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age ≤4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95% confidence interval: 1.61-8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis.
Conclusions:
Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare.
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