Cleveland Clinic Foundation cleveland, OH, United States
Manik Aggarwal, MD, Prabhat Kumar, MBBS, Rajat Garg, MD, Christina C. Lindenmeyer, MD, Jamile Wakim-Fleming, MD, Alberto Rubio-Tapia, MD Cleveland Clinic Foundation, Cleveland, OH
Introduction: Celiac disease (CD) is a recognized etiology of abnormal liver biochemistries (LBC); the prevalence of this finding at the time of CD diagnosis ranges from 10-50%. Previous studies have reported conflicting prevalence rates of abnormal LBC; in addition, the factors related to abnormal LC in CD are not well understood. We performed a systematic review and meta-analysis to assess (1) the prevalence of abnormal LC at the time of CD diagnosis and (2) the prevalence of CD in patients with cryptogenic elevation of LC (CLBC).
Methods: A systematic search utilizing multiple databases (From Jan 1, 1995 to Feb 18, 2021) to identify studies describing the prevalence and factors
associated with abnormal LC in CD was performed. Studies assessing (1) serum aminotransferases in newly diagnosed CD patients and (2)
serological tests for CD in patients with CHT were included in the analysis. Only studies with ≥50 CD cases with the majority of participants
>15 years of age were included.
Results: A total of 20 studies inclusive of 4265 participants (mean age =36 years, 70% female) that assessed prevalence of abnormal LBC in newly diagnosed CD patients were included in the final analysis. Pooled prevalence of abnormal LBC was 18.7% (95% CI=13.8-24.8; I2=95%) (Figure 1A). Response after gluten free diet (GFD) (range of follow-up 6-48 months) was reported in 11 studies; normalization of previously abnormal LC was reported in 83.1% of patients (95% CI= 73.4-89.7; I2=79%) (Figure 1B). On meta-regression, age at CD diagnosis (p=0.14), gender (p=0.54) and Marsh grading (p=0.56) were not found to be associated with abnormal LBC.
Seven studies including 979 cases reported rates of CD in CLC. Pooled prevalence of positive CD serology was 6.4% (95% CI= 2.9-10.3; I2=71%) (Figure 2A) and positive histology for CD was 4.5% (95% CI= 2.6-7.7; I2=66%) (Figure 2B). Malabsorptive symptoms were seen in 9/38 (24%) patients with positive serology.
Discussion: Abnormal LBC are seen in approximately 20% of patients at the time of CD diagnosis; the majority of LBC normalize after institution of
GFD, suggesting a high prevalence of celiac hepatitis. Age, gender and Marsh Grade are not associated with abnormal LBC. The prevalence
of biopsy-proven CD in patients with CLBC is less than 5%, with the majority of patients lacking typical symptoms such as diarrhea. Further
study is indicated to identify factors that predispose patients with CD to abnormal LBC and celiac hepatitis, as well as the clinical
consequences of this condition.
Figure: Figure 1 Prevalence of abnormal liver biochemistries (LBCs) in newly diagnosed celiac disease (CD) (Figure 1A) and response to gluten free diet (Figure 1B). Figure 2 Rates of positive CD serology (Figure 2A) and positive CD histology (Figure 2B) in patients with cryptogenic elevation of liver biochemistries.
Disclosures: Manik Aggarwal indicated no relevant financial relationships. Prabhat Kumar indicated no relevant financial relationships. Rajat Garg indicated no relevant financial relationships. Christina Lindenmeyer indicated no relevant financial relationships. Jamile Wakim-Fleming indicated no relevant financial relationships. Alberto Rubio-Tapia indicated no relevant financial relationships.
Manik Aggarwal, MD, Prabhat Kumar, MBBS, Rajat Garg, MD, Christina C. Lindenmeyer, MD, Jamile Wakim-Fleming, MD, Alberto Rubio-Tapia, MD. P0920 - Abnormal Liver Biochemistries in Celiac Disease: Systematic Review and Meta-analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.