A study published in Gastroenterology (April 2002; 122:881–888) described four patients with chronic liver disease who were ultimately found to have celiac disease. In three of the four cases, liver function improved or normalized after the patients adopted a strict gluten-free diet. The fourth patient did not adhere to the diet and experienced progressive liver failure, eventually requiring a liver transplant.
The researchers then screened 185 patients awaiting liver transplantation and found that approximately 4% had undiagnosed celiac disease—a prevalence far higher than expected in the general population.
Celiac disease is an immune-mediated reaction to gluten that damages the small intestine and interferes with nutrient absorption. While classic symptoms include abdominal pain, bloating, diarrhea, and fatigue, celiac disease can also present with extra-intestinal manifestations, including abnormal liver enzymes and autoimmune liver disease.
The authors concluded that celiac disease should be considered and ruled out in cases of unexplained hepatitis or autoimmune liver disease, particularly when standard evaluation does not reveal a clear cause.
