Changing Epidemiology of Liver Involvement in Children with 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 ALT levels were >40 U/L (hypertransaminasemia, HTS). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet (GFD). 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 AST levels in the HTS group were 57 U/L (IQR 49–80 U/L) and 67 U/L (IQR 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 (OR 3.73; 95% CI: 1.61 - 8.66). When retested on a GFD, all but three patients normalized ALT levels; of these, one 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.