Liver Involvement in Celiac Disease

Celiac disease (CD) is being found to present as a liver disorder in 5-10% of patients with a persistent and cryptogenetic elevation of serum aminotransferase activity. A wide spectrum of liver injuries in children and adults may be related to CD and in particular (i) mild parenchymal damage characterised by the absence of any clinical sign or symptom suggesting a chronic liver disease, and by non-specific histological changes reversible on a gluten-free diet; (ii) a chronic inflammatory liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis that may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive treatment; and (iii) a severe liver failure potentially treatable by a gluten-free diet. Cross-checking for asymptomatic liver damage in CD and conversely, for CD in any cryptogenic liver disorder, including end-stage liver failure, is recommended.