Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Thursday, 05 / 13 / 2021




Celiac Disease and Elevated Liver Enzymes: A Still Not Fully Defined Pathogenesis

Linda Beenet1,*  and Diego Tonesi2

1  Department of Pathology & Laboratory Medicine, University of California Los Angeles (UCLA) Technology Center for Genomics & Bioinformatics, Los Angeles, CA, USA
2  Gastroenterology and Endoscopy Unit, Ospedale Maggiore Policlinico, Milan, Italy
*Correspondence to: Linda Beenet, Department of Pathology & Laboratory Medicine, University of California Los Angeles (UCLA) Technology Center for Genomics & Bioinformatics Los Angeles, CA 90095, USA. ORCID: Tel: +1-310-206-4520, Fax: +1-310-206-4520, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(2):274-275 DOI: 10.14218/JCTH.2021.00074
Received: February 20, 2021 Accepted: March 21, 2021 Published online: April 7, 2021

Dear Editor,

We read, with great interest, the comprehensive review by Villavicencio Kim J and Wu GY that systematically addressed the issue of liver enzyme elevation in celiac disease (CD) patients.1

The Authors reviewed, in detail, the most relevant studies reporting the frequency of liver enzyme elevation in CD patients and the possible causes, discussing the hypothesis that this elevation may be a clue to associated liver disease or an epiphenomenon, possibly secondary to the increased intestinal permeability that is known to characterize CD patients, especially at diagnosis, before starting a gluten-free diet.2

We would like to add some considerations that, in our opinion, could have implications in the pathogenesis of hepatic injury in CD.

As known, it has been reported that CD is frequently associated with other extraintestinal autoimmune diseases or even with the mere presence of autoantibodies without concomitant autoimmune pathology.3–6

Among the autoimmune diseases potentially associated with CD, autoimmune hepatitis (AIH) is worthy of mention, as previously reported.1,3,7

Of considerable interest, it has been reported that celiac patients frequently have anti-filamentous actin IgA antibodies that have shown reliable and significant correlation with villous atrophy.8 These autoantibodies, although of IgG class, are also known to have very high specificity for AIH.7,9

This similarity between the two autoimmune diseases could be a clue that also supports possible immune-mediated pathogenesis of hypertransaminasemia in CD patients. Therefore, it would be relevant and worthy of study to analyze the presence of anti-actin antibodies in CD patients to verify whether these antibodies are markers of liver injury.

Finally, it should not be overlooked, the very remarkable issue of the potential development of hepatic steatosis, which, as appropriately mentioned by the Authors, is not uncommon in CD patients with celiac disease after starting a gluten-free diet.10

Journal of Clinical and Translational Hepatology 2021 vol. 9, 274-275  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


You are here: Home