Abstract
Aim: To determine the prevalence of patients with hepatic injury related to celiac disease.
Method: Retrospective analysis of patients’ records from Hepatology Outpatient Clinic in the period of 18 months was done. Data regarding referral and final diagnosis as well as hepatic injury profile were analysed.
Results: There were 1207 exams performed in 684 patients, and only 446 of them with initial diagnosis suggesting liver disease. Elevated liver enzymes had 299/446 patients (67%), and only in 30% of them (89/299) proper screening for metabolic, viral, and autoimmune diseases was done. None of referred (0%) patients was screened for celiac disease. Finally, in 248 patients diagnosis of either viral hepatitis, NAFLD/NASH, ALD, haemochromatosis, autoimmune liver disease, Gilbert syndrome, toxic liver injury and even primary aceruloplasminemia, was established. In five patients celiac disease was already established, but additional liver disease was suspected and confirmed, but there were still 52 patients with no diagnosis. In 9 of those 52 patients (17%), celiac disease was diagnosed with positive tissue transglutaminase antibodies and confirmed with duodenal mucosa biopsy.
Conclusion: Our data suggest that the prevalence of celiac disease in adult population with hepatic injury is up to 17%. Celiac disease can be the sole cause of hepatic injury, meaning celiac hepatitis, but can also be combined with other autoimmune diseases of the liver as well as with steatohepatitis. High level of suspicion is necessary to recognize disease early, and that is the reason why serology testing for celiac disease should be positioned high in the algorithm of liver injury workup.
Keywords: Celiac Disease; Celiac Hepatitis; Screening; Liver Injury Workup
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