Systematic review: the liver in coeliac disease

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.