Bi-directional Relationship Between Celiac Disease and Liver Chemistries: A Systematic Review and Meta-Analysis

• Published in: Digestive diseases and sciences Vol. 68; no. 4; pp. 1369 - 1380
• Main Authors: Aggarwal, Manik, Garg, Rajat, Kumar, Prabhat, Lindenmeyer, Christina C., Wakim-Fleming, Jamile, Jansson-Knodell, Claire, Rubio-Tapia, Alberto
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2023; Springer Nature B.V
• Subjects: Adult; Age; Alanine Transaminase; Biochemistry; Biopsy; Body mass index; Celiac disease; Celiac Disease - complications; Celiac Disease - diagnosis; Celiac Disease - epidemiology; Child; Diet, Gluten-Free - methods; Estimates; Female; Food allergies; Gastroenterology; Gender; Gluten; Hepatitis; Hepatology; Humans; Liver; Liver diseases; Liver Function Tests; Male; Medicine; Medicine & Public Health; Meta-analysis; Nutrition research; Oncology; Original Article; Pediatrics; Regression analysis; Seroepidemiologic Studies; Serology; Statistical analysis; Systematic review; Transplant Surgery; Gluten sensitivity; Gluten-free diet; Celiac disease; Aminotransferase; Liver injury; Resolution
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-022-07663-w

Aims Previous studies have reported conflicting results regarding prevalence of elevated LC (2–70%) in celiac disease (CD). This systematic review and meta-analysis assessed the prevalence of elevated LC at time of CD diagnosis and associated response to GFD. We also report the prevalence of CD in patients with unexplained elevation of LC. Methods Studies assessing LC (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) in CD patients were eligible. Studies with < 50 cases or in pediatric populations were excluded. Results In total, 20 studies assessing prevalence of elevated LC in 4,265 participants with newly diagnosed CD (mean age = 35.6 ± 6.5 years, 69.8% female) were included. Pooled prevalence of elevated LC was 18.7% (95% CI 13.8–24.8; I2 = 95%). Normalization of elevated LC was seen in 83.1% (95% CI 73.4–89.7; I2 = 79%, 11 studies) of patients after GFD. On meta-regression, age at CD diagnosis, gender, and Marsh grading were not associated with elevated LC. Among 979 participants (7 studies) with unexplained elevation of LC, pooled seroprevalence and biopsy-proven CD was 6.4% (95% CI 2.9–10.3, I2 = 71%) and 4.5% (95% CI 2.6–7.7, I2 = 67%), respectively. Conclusion Elevated LC are seen in approximately one-fifth of patients at CD diagnosis with majority normalizing after GFD. Age, gender, and degree of intestinal damage are not predictive of elevated LC. In the appropriate clinical scenario, liver tests should be serially monitored in CD reserving workup for additional causes after a trial of GFD. Patients with unexplained elevation of liver tests should be screened for celiac disease.