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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31828dc5c5
Original Articles: Hepatology and Nutrition

Pediatric Celiac Disease, Cryptogenic Hypertransaminasemia, and Autoimmune Hepatitis

Vajro, Pietro*; Paolella, Giulia*; Maggiore, Giuseppe; Giordano, Giuseppe

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Objective: The association between celiac disease (CD) and liver disease in pediatrics is widely recognized, but its prevalence is unknown. This study aims to conduct a systematic review and meta-analysis to evaluate the prevalence of CD in children with cryptogenic persistent hypertransaminasemia (HTS) or autoimmune hepatitis (AIH), and vice versa.

Methods: We searched MEDLINE/PubMed, the Cochrane Library, Web of Science, and MD Consult from 1977 to May 2012 for studies reporting either CD and HTS or AIH. Pooled prevalences with 95% confidence intervals (CI) and relative risk (RR) were calculated.

Results: Nine studies (2046 patients) were identified. Pooled prevalences of CD in children with mild, nonspecific cryptogenic persistent HTS and vice versa were 12.0% (95% CI 4.17–29.96) and 36.0% (95% CI 32.15–40.11), respectively. A gluten-free diet normalized transaminase levels in 77% to 100% of patients with CD within 4 to 8 months. Pooled prevalences of CD in children with AIH and vice versa were 6.3% (95% CI 3.87–11.73) and 1.4% (95% CI 0.84–2.15), respectively. The RR of HTS in children with CD versus the general population, and of CD in children with HTS was 6.55 (95% CI 5.65–7.60) and 11.59 (95% CI 3.80–35.33), respectively. The corresponding RR of AIH in children with CD was 188.54 (95% CI 92.23–385.43). The RR of CD in children with AIH was 6.63 (95% CI 3.86–11.40).

Conclusions: CD is associated with elevated transaminase levels in about one-third of newly diagnosed children. Cryptogenic persistent HTS may signal gluten-dependent nonspecific mild hepatitis (12.0% of cases) or more rarely (6.3%) severe CD-related autoimmune hepatopathy. RRs confirm these trends in the considered associations.

Copyright 2013 by ESPGHAN and NASPGHAN


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