Evaluation of hepatopancreatobiliary pathologies in celiac disease patients

Introduction Celiac disease is a permanent intolerance of dietary wheat gluten, and it presents as enteropathy in genetically predisposed individuals. Although the small bowel is one of the main targets of the disease, the condition is nowadays conceived as an autoimmune-mediated systemic disorder that possibly affecting other organs such as the nervous system, skin, bone, pancreas and liver. Guidelines recommend routine screening of liver function tests in patients with celiac disease. However, there are limited data on liver and pancreatic enzyme elevations in celiac patients. The aim of this study was to evaluate liver and pancreatic enzyme elevations in patients with celiac disease. Material and methods This study was conducted with 222 patients with a serologically and / or histologically diagnosed as celiac disease. The age and gender of the patients were recorded. Among the liver function tests, alanine aminotransaminase (ALT), aspartate aminotransaminase (AST), gama glutamyl transferase (GGT), alkaline phosphatase (ALP) values were included in the study. Amylase and lipase values among pancreatic enzymes were recorded. Among the serological markers of celiac disease, tissue transglutaminase IgA (IgA-TTG) and endomysial antibody IgA (IgA-EMA) results were evaluated. The liver function tests and exocrine pancreatic enzymes were performed simultaneously with the serological tests requested at the time of diagnosis. Patients with primary liver disease were excluded from the study. Patients with hepatosteatosis were identified by abdominal ultrasonography (US). Results The average age of the patients was 37.1 ± 11.0 years. 77.9% of the patients (173/222) were female. Elevation of AST, ALT, GGT, ALP levels were observed in 14.9% (33/222), 6.3% (14/222), 2.9% (6/205), and 1.5% (3/204), respectively. 15.8% of coeliac patients (33/222) had elevated aminotransaminases. Elevation of amylase and lipase were observed only in 1.3% (2/156) and 2.6% (4/152) of the patients. Hepatosteatosis was observed in 16.1% of the patients in abdominal US imaging. After excluding patients with hepatosteatosis, 16.1% of coeliac patients (32/199) had elevated aminotransaminases. AST, ALT, GGT and ALP levels were higher in male patients than in women (p<0.05). Aminotransferase elevation was higher in IgA-TTG (p=0.035) and IgA-EMA (p=0.036) positive celiac patients. Conclusion In conclusion, newly diagnosed coliac patients without known primer liver disease, have a high prevalence of hypertransaminasemia. The proportion of patients with increased aminotransferase remain high even when patients with hepatosteatosis are excluded. Aminotransferase elevation in untreated celiac patients may not always indicate liver disease. Key words: Coliac disease, Liver function, Hypertransaminasemia, Exocrine pancreatic enzymes.