Liver involvement in pediatric celiac disease

Table 1 Studies reporting the prevalence of cryptogenic hypertransaminasemia in children and adolescents with celiac disease

Ref.	Study design	Study population with CD	Diagnosis of CD	Number of patients with elevated transaminases	Effect of GFD	Comment
Bonamico et al[9], 1986	Observational	65 untreated symptomatic children aged 6-mo to 18 yr	Intestinal biopsy	37 (56.9%) had elevated (> 45 U/L) ALT (3.1%) or AST (29.2%) or both (24.6%)	Only 5 cases had a follow-up for 3-4 wk after GFD: normalization of transaminases was achieved in all	Excluded were Hepatitis A and B, but not other causes of liver disease
Farre et al[13], 2002	Prospective	114 untreated symptomatic children aged 9-mo to 17 yr	Serology (EMA IgA or IgG and tTGA IgA) and/or intestinal biopsy	37 (32.0%) had elevated1 ALT-or- AST (14.9%) or both (14.9%)	35 of 37 had a follow-up for 9-18 mo after GFD: normalization of transaminases was achieved in all
Arslan et al[14], 2005	Observational	27 untreated symptomatic children with a mean age of 6 (SD 5) years	Serology (EMA IgA and AGA IgA/IgG) and/or intestinal biopsy	7 (25.9%) had elevated ALT (> 45 U/L)	All patients had normalization of transaminases after 2-11 mo of GFD
Di Biase et al[15], 2010	Prospective	350 untreated children with suspected CD aged 1 to 16 yr	Serology and intestinal biopsy according to the ESPGHAN criteria	140 (40.0%) had elevated AST (≥ 38 U/L) and/or ALT (≥ 41 U/L); four with values > 5 times upper normal levels	Normalization of transaminases after 6 mo of GFD was achieved in 133 (97.8%) of 136 children with transaminase values < 5 times upper normal levels	The four children with transaminase values > 5 times upper normal levels as well as the 3 children with persistent elevated transaminases had further laboratory investigation and were found to be affected by autoimmune hepatitis

¹Normal reference values for AST < 50 U/L from 1 to 6 years, < 38 U/L from 6 to 18 years; for ALT < 31 U/L from 1 to 18 years. CD: Celiac disease; GFD: Gluten-free diet; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; IgA: Immunoglobulin A; IgG: Immunoglobulin G; EMA: Anti-endomysial antibodies; tTGA: Anti-tissue transglutaminase antibodies; AGA: Anti-gliadin antibodies; ESPGHAN: European Society for Paediatric Gastroenterology, Hepatology and Nutrition.