Post by kickingfrog on Feb 2, 2011 10:46:14 GMT
Liver & CD
Gluten May Trigger Liver Failure Related to Celiac Disease
"The possible presence of celiac disease should be investigated in patients with severe liver disease," write Katri Kaukinen, from Tampere University Hospital in Finland, and colleagues. "Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered."
Of the 4 patients with severe liver disease and celiac disease in the study, 1 patient had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Although liver transplantation was imminent in 3 of these patients, a gluten-free diet improved hepatic function in all 4 patients. In 185 adults with previous liver transplantation, 8 patients (4.3%) had celiac disease, including 6 diagnosed preoperatively and 2 detected on screening using serum immunoglobulin A endomysial and tissue transglutaminase antibodies. Only 1 patient had maintained a long-term, strict gluten-free diet.
"Not all of our patients with severe liver failure and celiac disease had apparent symptoms compatible with celiac disease, suggesting that the celiac disease-related liver involvement was not necessarily a complication of malabsorption," the authors write. "Rather, it may well be a gluten-dependent immunologically induced extraintestinal manifestation of celiac disease."
www.medscape.com/viewarticle/431589
*************************
Gastroenterology
Volume 122, Issue 4 , Pages 881-888, April 2002
Celiac disease in patients with severe liver disease: Gluten-free diet may reverse hepatic failure
Katri Kaukinen et al
Departments of Internal Medicine and Pediatrics, Tampere University Hospital, Tampere, and Medical School and Institute of Medical Technology, University of Tampere, Tampere
,
,
Received 18 June 2001; accepted 13 December 2001
Abstract
Background & Aims: Mild liver abnormalities are common in patients with celiac disease and usually resolve with a gluten-free diet. We investigated the occurrence of celiac disease in patients with severe liver failure.
Methods: Four patients with untreated celiac disease and severe liver disease are described. Further, the occurrence of celiac disease was studied in 185 adults with previous liver transplantation using serum immunoglobulin A endomysial and tissue transglutaminase antibodies in screening.
Results: Of the 4 patients with severe liver disease and celiac disease, 1 had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Three were even remitted for consideration of liver transplantation. Hepatic dysfunction reversed in all cases when a gluten-free diet was adopted. In the transplantation group, 8 patients (4.3%) had celiac disease. Six cases were detected before the operation: 3 had primary biliary cirrhosis, 1 had autoimmune hepatitis, 1 had primary sclerosing cholangitis, and 1 had congenital liver fibrosis. Only 1 patient had maintained a long-term strict gluten-free diet. Screening found 2 cases of celiac disease, 1 with autoimmune hepatitis and 1 with secondary sclerosing cholangitis.
Conclusions: The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.
GASTROENTEROLOGY 2002;122:881-888
******************
Systematic review: the liver in coeliac disease.
Posted by Jackie MOT on 20/3/2005
Another reason for staying strictly GF?!?
Duggan JM, Duggan AE.
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia.
Summary 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.
www.ncbi.nlm.nih.gov/pubmed/15740533?dopt=Abstract
***************
Cirrhosis in Children With Celiac Disease.
Posted by Jackie Mum of twins on 17/7/2005
GF board
BACKGROUND:: Liver involvement represents an extra-intestinal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of cirrhosis with CD in 5 children. PATIENTS AND METHODS:: The mean age of the patients was 9.4 +/- 2.8 years. Viral, metabolic, and autoimmune etiology of liver disease was ruled out. Intestinal and liver biopsies were performed to confirm the histologic diagnosis in all subjects. RESULTS:: Three of the patients had chronic diarrhea and hepatosplenomegaly in whom diagnoses of CD and cirrhosis were established at presentation simultaneously. In the other 2 patients, CD was diagnosed following an initial diagnosis of cirrhosis. At diagnosis, alanine aminotransferase (range, 64-271 IU/L) and aspartate aminotransferase (range, 90-225 IU/L) values were elevated. After 1 to 5 years of a gluten-free diet (GFD), normalization of serum aminotransferase levels and clinical improvement were observed in 3 patients with strict GFD. The other 2 patients without improvement of the liver disease had poor dietary compliance. CONCLUSION:: CD may be associated with severe hepatic damage in children and strict GFD may have beneficial effect on the course of liver disease. Serologic screening of CD should be included in differential diagnosis of chronic liver disease of unknown origin.
www.ncbi.nlm.nih.gov/pubmed/16000933?dopt=Abstract
********************************************
Journal of Pediatric Gastroenterology & Nutrition: Volume 28(5) May 1999 p 576
COELIAC DISEASE ASSOCIATED WITH ACUTE LIVER FAILURE
Casswall, T. H.; Németh, A.
Dept. of Pediatrics Karolinska Institutet, Huddinge University Hospital, Sweden
Abstract 9
The aetiology, pathogenesis and/or triggering factors of both coeliac disease (CD) and acute liver failure (ALF) are still largely unknown. Light to moderate liver damage has earlier been observed in children with CD. Only scattered cases of ALF, associated with CD have been reported and none of them was irreversible ...
Results: Three of our last 27 infants and children with ALF developed their organ failure shortly after onset of their CD. All three girls were initially breast-fed and along with gluten, also cow's milk protein was introduced. Adenovirus type 2 was found in the urine of one of the girls, otherwise no viral cause could be found. While in one of them the liver failure, but not the CD, receded on extreme hypoimmunogenic diet, in the other 2 emergency OLT had to be performed. Before normal intestinal biopsy was obtained, apart from gluten-free diet also prednisolone was administered to all of them, in 2 because of the organ transplant and in the third one because of therapy-resistant CD and threatening lymphoma. Cow's milk reintroduction did not result in recurrence of the symptoms
....
Discussion: The association between CD and ALF could be explained by a) common viral cause, b) as a result of an immune response to food intolerance or c) induced by increased macromolecular uptake due to mucosal damage. With 3 cases of 27 (11%) a coincidence seems to be rather improbable. It could be an effect of the striking rise in the incidence of CD in Sweden in the last decade, which on its turn could be caused by the increased gluten intake at introduction .. This could lead to an immune response leading to ALF.
Conclusion: Early detection of infantile CD is essential in order to prevent serious associated complications including even ALF.
1) Cassagnou M. et al. Am J Gastroenterol 1996:91;1291-2
...
2) Ascher H. et al. Arch Dis Child 1993:69;375-80
...
Section Description
HEPATOLOGY
© 1999 Lippincott Williams & Wilkins, Inc.
********************
CD/Liver
Posted by Charlotte, Oxford on 18/6/2009
GF board
I have these notes from previous postings and some refs. There are lots.
CD and Liver
There are two areas affecting coeliacs:
a) A large proportion of adult-diagnosed coeliacs have mildly elevated liver enzymes which tend to normalise with dietary treatment. Usually this does not need any treatment.
b) A much smaller proportion of coeliacs come to their dx via hepatology, sometimes having been dx with advanced liver disease. Liver function can improve in these cases but if linked to serious conditions like PBC may still present problems. Focus here should be on increasing awareness of the presence of CD in some liver patients because often damage is preventable. There is a still a lack of awareness of this link in many consultants.
Finally CD and liver disease may be complicated by other issues such as pancreatic failure (and SIBO?). This can be easily checked for. Understanding of the full connection between these conditions is still very understudied (partly because CD is mainly studied by gastroenterologists). It is often up to patients to suggest these investigations.
Is coeliac disease a potentially treatable cause of liver failure?
www.ncbi.nlm.nih.gov/pubmed/16148544
European Journal of Gastroenterology & Hepatology. 17(10):1015-1017, October 2005.
Stevens, Fiona M. a; McLoughlin, Ramona M. b
Abstract:
* Hypertransaminasaemia occurs in up to 40% of patients with coeliac disease and resolves with a gluten-free diet.
* Chronic liver disease such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and chronic autoimmune hepatitis is associated with coeliac disease.
* Coeliac disease is up to 10 times more frequent among patients with chronic liver disease than the general population.
* Increased intestinal permeability, small intestinal bacterial overgrowth, Kupffer cell abnormalities, direct toxicity of gliadin peptides, or a gliadin-stimulated immunopathological process may have a role to play in the progression of chronic liver disease among coeliac patients.
* The institution of a gluten-free diet leads to an improvement in those patients with liver failure and previously undiagnosed coeliac disease.
….
Hepatobiliary and pancreatic disorders in celiac disease
Hugh James Freeman Department of Medicine (Gastroenterology), University of British Columbia, Vancouver,
www.wjgnet.com/1007-9327/12/1503.asp
Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet.
www.ncbi.nlm.nih.gov/pubmed/7657 ... t=Abstract
Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D.
Cattedra di Gastroenterologia, Università degli Studi di Milano, IRCCS Ospedale Maggiore, Italy.
We conclude that in adult celiac patients elevated serum transaminases are a frequent finding and normalize in most cases after GFD. When they persist, liver biopsy is mandatory to further investigate hepatic involvement..
Systematic review: the liver in coeliac disease
J. M. Duggan* & A. E. Duggan
www.ncbi.nlm.nih.gov/pubmed/15740533
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.
Coeliac disease and liver dysfunction REVIEW
S Davison Paediatric Liver and GI Unit, St James s University Hospital, Leeds, UK
www.pubmedcentral.nih.gov/articl ... id=1763026
****************
Gluten May Trigger Liver Failure Related to Celiac Disease
"The possible presence of celiac disease should be investigated in patients with severe liver disease," write Katri Kaukinen, from Tampere University Hospital in Finland, and colleagues. "Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered."
Of the 4 patients with severe liver disease and celiac disease in the study, 1 patient had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Although liver transplantation was imminent in 3 of these patients, a gluten-free diet improved hepatic function in all 4 patients. In 185 adults with previous liver transplantation, 8 patients (4.3%) had celiac disease, including 6 diagnosed preoperatively and 2 detected on screening using serum immunoglobulin A endomysial and tissue transglutaminase antibodies. Only 1 patient had maintained a long-term, strict gluten-free diet.
"Not all of our patients with severe liver failure and celiac disease had apparent symptoms compatible with celiac disease, suggesting that the celiac disease-related liver involvement was not necessarily a complication of malabsorption," the authors write. "Rather, it may well be a gluten-dependent immunologically induced extraintestinal manifestation of celiac disease."
www.medscape.com/viewarticle/431589
*************************
Gastroenterology
Volume 122, Issue 4 , Pages 881-888, April 2002
Celiac disease in patients with severe liver disease: Gluten-free diet may reverse hepatic failure
Katri Kaukinen et al
Departments of Internal Medicine and Pediatrics, Tampere University Hospital, Tampere, and Medical School and Institute of Medical Technology, University of Tampere, Tampere
,
,
Received 18 June 2001; accepted 13 December 2001
Abstract
Background & Aims: Mild liver abnormalities are common in patients with celiac disease and usually resolve with a gluten-free diet. We investigated the occurrence of celiac disease in patients with severe liver failure.
Methods: Four patients with untreated celiac disease and severe liver disease are described. Further, the occurrence of celiac disease was studied in 185 adults with previous liver transplantation using serum immunoglobulin A endomysial and tissue transglutaminase antibodies in screening.
Results: Of the 4 patients with severe liver disease and celiac disease, 1 had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Three were even remitted for consideration of liver transplantation. Hepatic dysfunction reversed in all cases when a gluten-free diet was adopted. In the transplantation group, 8 patients (4.3%) had celiac disease. Six cases were detected before the operation: 3 had primary biliary cirrhosis, 1 had autoimmune hepatitis, 1 had primary sclerosing cholangitis, and 1 had congenital liver fibrosis. Only 1 patient had maintained a long-term strict gluten-free diet. Screening found 2 cases of celiac disease, 1 with autoimmune hepatitis and 1 with secondary sclerosing cholangitis.
Conclusions: The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.
GASTROENTEROLOGY 2002;122:881-888
******************
Systematic review: the liver in coeliac disease.
Posted by Jackie MOT on 20/3/2005
Another reason for staying strictly GF?!?
Duggan JM, Duggan AE.
Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia.
Summary 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.
www.ncbi.nlm.nih.gov/pubmed/15740533?dopt=Abstract
***************
Cirrhosis in Children With Celiac Disease.
Posted by Jackie Mum of twins on 17/7/2005
GF board
BACKGROUND:: Liver involvement represents an extra-intestinal feature of celiac disease (CD) and shows a clinical spectrum varying from nonspecific reactive hepatitis to cirrhosis. Here we report the association of cirrhosis with CD in 5 children. PATIENTS AND METHODS:: The mean age of the patients was 9.4 +/- 2.8 years. Viral, metabolic, and autoimmune etiology of liver disease was ruled out. Intestinal and liver biopsies were performed to confirm the histologic diagnosis in all subjects. RESULTS:: Three of the patients had chronic diarrhea and hepatosplenomegaly in whom diagnoses of CD and cirrhosis were established at presentation simultaneously. In the other 2 patients, CD was diagnosed following an initial diagnosis of cirrhosis. At diagnosis, alanine aminotransferase (range, 64-271 IU/L) and aspartate aminotransferase (range, 90-225 IU/L) values were elevated. After 1 to 5 years of a gluten-free diet (GFD), normalization of serum aminotransferase levels and clinical improvement were observed in 3 patients with strict GFD. The other 2 patients without improvement of the liver disease had poor dietary compliance. CONCLUSION:: CD may be associated with severe hepatic damage in children and strict GFD may have beneficial effect on the course of liver disease. Serologic screening of CD should be included in differential diagnosis of chronic liver disease of unknown origin.
www.ncbi.nlm.nih.gov/pubmed/16000933?dopt=Abstract
********************************************
Journal of Pediatric Gastroenterology & Nutrition: Volume 28(5) May 1999 p 576
COELIAC DISEASE ASSOCIATED WITH ACUTE LIVER FAILURE
Casswall, T. H.; Németh, A.
Dept. of Pediatrics Karolinska Institutet, Huddinge University Hospital, Sweden
Abstract 9
The aetiology, pathogenesis and/or triggering factors of both coeliac disease (CD) and acute liver failure (ALF) are still largely unknown. Light to moderate liver damage has earlier been observed in children with CD. Only scattered cases of ALF, associated with CD have been reported and none of them was irreversible ...
Results: Three of our last 27 infants and children with ALF developed their organ failure shortly after onset of their CD. All three girls were initially breast-fed and along with gluten, also cow's milk protein was introduced. Adenovirus type 2 was found in the urine of one of the girls, otherwise no viral cause could be found. While in one of them the liver failure, but not the CD, receded on extreme hypoimmunogenic diet, in the other 2 emergency OLT had to be performed. Before normal intestinal biopsy was obtained, apart from gluten-free diet also prednisolone was administered to all of them, in 2 because of the organ transplant and in the third one because of therapy-resistant CD and threatening lymphoma. Cow's milk reintroduction did not result in recurrence of the symptoms
....
Discussion: The association between CD and ALF could be explained by a) common viral cause, b) as a result of an immune response to food intolerance or c) induced by increased macromolecular uptake due to mucosal damage. With 3 cases of 27 (11%) a coincidence seems to be rather improbable. It could be an effect of the striking rise in the incidence of CD in Sweden in the last decade, which on its turn could be caused by the increased gluten intake at introduction .. This could lead to an immune response leading to ALF.
Conclusion: Early detection of infantile CD is essential in order to prevent serious associated complications including even ALF.
1) Cassagnou M. et al. Am J Gastroenterol 1996:91;1291-2
...
2) Ascher H. et al. Arch Dis Child 1993:69;375-80
...
Section Description
HEPATOLOGY
© 1999 Lippincott Williams & Wilkins, Inc.
********************
CD/Liver
Posted by Charlotte, Oxford on 18/6/2009
GF board
I have these notes from previous postings and some refs. There are lots.
CD and Liver
There are two areas affecting coeliacs:
a) A large proportion of adult-diagnosed coeliacs have mildly elevated liver enzymes which tend to normalise with dietary treatment. Usually this does not need any treatment.
b) A much smaller proportion of coeliacs come to their dx via hepatology, sometimes having been dx with advanced liver disease. Liver function can improve in these cases but if linked to serious conditions like PBC may still present problems. Focus here should be on increasing awareness of the presence of CD in some liver patients because often damage is preventable. There is a still a lack of awareness of this link in many consultants.
Finally CD and liver disease may be complicated by other issues such as pancreatic failure (and SIBO?). This can be easily checked for. Understanding of the full connection between these conditions is still very understudied (partly because CD is mainly studied by gastroenterologists). It is often up to patients to suggest these investigations.
Is coeliac disease a potentially treatable cause of liver failure?
www.ncbi.nlm.nih.gov/pubmed/16148544
European Journal of Gastroenterology & Hepatology. 17(10):1015-1017, October 2005.
Stevens, Fiona M. a; McLoughlin, Ramona M. b
Abstract:
* Hypertransaminasaemia occurs in up to 40% of patients with coeliac disease and resolves with a gluten-free diet.
* Chronic liver disease such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and chronic autoimmune hepatitis is associated with coeliac disease.
* Coeliac disease is up to 10 times more frequent among patients with chronic liver disease than the general population.
* Increased intestinal permeability, small intestinal bacterial overgrowth, Kupffer cell abnormalities, direct toxicity of gliadin peptides, or a gliadin-stimulated immunopathological process may have a role to play in the progression of chronic liver disease among coeliac patients.
* The institution of a gluten-free diet leads to an improvement in those patients with liver failure and previously undiagnosed coeliac disease.
….
Hepatobiliary and pancreatic disorders in celiac disease
Hugh James Freeman Department of Medicine (Gastroenterology), University of British Columbia, Vancouver,
www.wjgnet.com/1007-9327/12/1503.asp
Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet.
www.ncbi.nlm.nih.gov/pubmed/7657 ... t=Abstract
Bardella MT, Fraquelli M, Quatrini M, Molteni N, Bianchi P, Conte D.
Cattedra di Gastroenterologia, Università degli Studi di Milano, IRCCS Ospedale Maggiore, Italy.
We conclude that in adult celiac patients elevated serum transaminases are a frequent finding and normalize in most cases after GFD. When they persist, liver biopsy is mandatory to further investigate hepatic involvement..
Systematic review: the liver in coeliac disease
J. M. Duggan* & A. E. Duggan
www.ncbi.nlm.nih.gov/pubmed/15740533
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.
Coeliac disease and liver dysfunction REVIEW
S Davison Paediatric Liver and GI Unit, St James s University Hospital, Leeds, UK
www.pubmedcentral.nih.gov/articl ... id=1763026
****************