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Dear Listmates:

I found this very interesting professional article in Medscape.
Registration is free.  Just click on http://www.medscape.com/ to view
the site and register so you can search for different subjects of
interest.  The following is an article about screening for celiac
disease in patients with chronic unexplained hypertransaminasemia:

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According to a report in the March 1999 issue of Hepatology, screening
for celiac disease (CD) appears to be an important tool in the initial
assessment of patients with chronic unexplained hypertransaminasemia.

Elevations in serum transaminase level are often associated with chronic
liver disease, including viral infections, cirrhosis, and
genetic/acquired metabolic disorders. However, chronic elevations of
serum transaminases often occur in the absence of comorbid liver disease
as well, as have been reported in patients with CD. Because of the
relatively high incidence of CD and the frequency of subclinical
presentation, it has been suggested that undiagnosed cases of CD may be
identified among patients with chronically elevated serum transaminases.


Bardella and coworkers tested 140 consecutive patients with chronic
unexplained hypertransaminasemia for antigliadin (AGA) and
antiendomysium (EmA) IgA antibodies by indirect immunofluorescence.
Results found that 13 of these subjects were positive for AGA and EmA
IgA; the 12/13 who subsequently consented to and underwent endoscopy and
distal duodenal biopsy showed histology consistent with CD. The
prevalence of celiac disease in this patient group was significantly
greater than that in the general population.

These findings suggest that chronic hypertransaminasemia may be a marker
of silent CD; screening for CD in patients with chronic elevations in
serum transaminases before investigations for rarer disease entities are
undertaken is therefore warranted.

Source: Bardella MT, Vecchi M, Conte D, et al: Chronic Unexplained
Hypertransaminasemia May Be Caused by Occult Celiac Disease. Hepatology
29:654-657, 1999.