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Liver pathology in children with newly diagnosed celiac disease
Kamila Agnieszka Kwiatek-Średzińska1, Katarzyna Kondej-Muszyńska1, Mirosława Uścinowicz1
1Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, Poland.
Insights
Liver pathology, including elevated liver enzymes and ultrasound changes, affects over 11% of children diagnosed with celiac disease (CD). Lower iron and folic acid levels were noted in affected children.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Celiac Disease Research
Background:
- Celiac disease (CD) is an autoimmune disorder triggered by gluten ingestion.
- Liver involvement in pediatric CD is not fully characterized at diagnosis.
Purpose of the Study:
- To determine the prevalence and types of liver pathology in children newly diagnosed with celiac disease.
- To identify potential associations between liver pathology and clinical/biochemical markers in pediatric CD.
Main Methods:
- Retrospective review of data from 149 newly diagnosed pediatric celiac disease patients.
- Liver pathology defined by elevated alanine transaminase (ALT) or gamma-glutamyl transpeptidase (GGT) serum activity, and/or abnormal liver ultrasound findings.
- Analysis of biochemical markers including iron, folic acid, vitamin B12, vitamin D, ferritin, and immunoglobulin A anti-tissue transglutaminase type 2 antibodies (IgA anti-TG2).
Main Results:
- Liver pathology was identified in 11.4% of children with newly diagnosed CD.
- Elevated ALT serum activity was present in 6.7% and abnormal liver ultrasound findings (enlargement, steatosis) in 8.1%.
- Children with liver pathology showed significantly lower iron and folic acid levels; a positive correlation was found between IgA anti-TG2 and ALT levels.
Conclusions:
- Liver pathology, manifesting as hypertransaminasemia and/or ultrasound abnormalities, is common at diagnosis in children with celiac disease.
- Lower iron and folic acid levels are associated with liver pathology in pediatric CD.
- A correlation exists between IgA anti-TG2 levels and ALT activity in these patients.
Aim Of The Study:
To evaluate the prevalence and the type of liver pathology in children at the time of diagnosis of celiac disease (CD).
Material And Methods:
Data from newly diagnosed children with CD hospitalized in the university hospital were retrospectively reviewed. Liver pathology was defined as elevated alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT) serum activity and/or pathological changes of the organ in ultrasound.
Results:
Liver pathology was detected in 17 of 149 children (11.4%). Ten patients (6.7%) had an elevated ALT serum activity, whereas no child had an elevated GGT activity. Pathological changes of liver in ultrasound (mainly enlargement or steatosis of the organ) were found in 12 patients (8.1%), of whom 5 children (3.4%) had simultaneously elevated ALT serum activity. Children with liver pathology had lower iron (Fe) (p = 0.02) and folic acid (p = 0.01) concentrations compared to the rest of the patients. There were no statistically significant differences between liver pathology existence and age, sex, serum immunoglobulin A anti-tissue transglutaminase type 2 antibodies (IgA anti-TG2), ferritin, vitamin B12, or vitamin D concentrations. Moreover, a positive correlation between IgA anti-TG2 concentration and ALT serum activity was found (p < 0.01, R = 0.29).
Conclusions:
Liver pathology is present at diagnosis in a significant proportion of children with CD in the form of hypertransaminasemia and pathological changes of the organ in ultrasound. There is a correlation between IgA anti-TG2 concentration and ALT serum activity.
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