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Changing Epidemiology of Liver Involvement in Children With Celiac Disease

Benelli, Elisa*; Naviglio, Samuele; De Leo, Luigina; Stera, Giacomo*; Giangreco, Manuela; Ronfani, Luca; Villanacci, Vincenzo; Martelossi, Stefano; Ventura, Alessandro*,†; Not, Tarcisio*,†

Journal of Pediatric Gastroenterology and Nutrition: April 2019 - Volume 68 - Issue 4 - p 547–551
doi: 10.1097/MPG.0000000000002209
Original Article: Gastroenterology: Celiac Disease

Objectives: Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15%–57%, autoimmune liver disease 1%–2%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD.

Methods: Children (age 0–18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet.

Results: CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9%), and were elevated in 27 (3.9%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49–80 U/L) and 67 U/L (interquartile range 53–85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age ≤4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95% confidence interval: 1.61–8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis.

Conclusions: Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare.

*Department of Medicine, Surgery, and Health Sciences, University of Trieste

Institute for Maternal and Child Health IRCCS ‘Burlo Garofolo’, Trieste

Pathology Section, Spedali Civili, Brescia, Italy.

Address correspondence and reprint requests to Samuele Naviglio, MD, Institute for Maternal and Child Health—IRCCS ‘Burlo Garofolo’, Via dell’Istria 65/1, 34137 Trieste, Italy (e-mail:

Received 18 August, 2018

Accepted 5 November, 2018

E.B. and S.N. contributed equally to this work.

This study was supported by the European Union—European Regional Development Fund (Interreg Central Europe “Focus in CD” project no. CE11).

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,