<<Disclaimer: Verify this information before applying it to your situation.>>

Systematic Review: The Liver in Coeliac Disease 
J.M. Duggan; A.E. Duggan 
Aliment Pharmacol Ther. 2005; 21 (5): 515-518. 

Background: For over a decade isolated reports have noted liver histology
and biochemistry changes in patients with coeliac disease. The prevalence
and response to treatment is clinically important.
Aim: To outline the frequency and significance of liver abnormalities in
coeliac disease.
Methods: A Medline search using Ovid-Coeliac/Coeliac (exp) and liver disease
(exp) was completed of English references published during 1966-June 2003.
Bibliographic references and other appropriate sources were also searched.
Results: Six studies reported liver biochemistry in 591 patients; 248
patients had abnormal results. Elevated transaminases were the most
frequently reported abnormality. A gluten-free diet produced resolution of
elevated transaminases in 115 of 130 patients. There was a greater than
expected association with primary biliary cirrhosis and advanced liver
disease.
Conclusions: Mildly abnormal liver biochemistry is frequent in untreated
coeliac disease and may provide a key to the diagnosis. Routine
investigations for undiagnosed liver disease should include tissue
transglutaminase testing. Left untreated, coeliac-induced hepatitis may
rarely progress to end-stage liver disease. Primary biliary cirrhosis is
clearly linked to coeliac disease. The full story of these linkages is yet
to be written. 
Introduction
There is growing evidence that a largely silent chronic liver abnormality
'cryptogenic-elevated transaminases' is frequently associated with untreated
coeliac disease in both children and adult patients. There is also a strong
association of primary biliary cirrhosis and coeliac disease. The link to
cirrhosis and other structural changes is less evident. This nexus requires
greater recognition as the response to a gluten-free diet is excellent. In
contrast, untreated there is evidence of occasional severe liver disease
including cirrhosis and mistreated there are the risks from long-term
steroids for misdiagnosed 'autoimmune hepatitis'.

* Please carefully compose your subject lines in all posts *