Abstract
Immunologically mediated liver diseases belong to the common extraintestinal manifestations of celiac disease. We have reviewed the current literature that addresses the association between celiac disease and liver disorders. We searched relevant articles on MEDLINE/PubMed up to 15 June 2018. The objective of the article is to provide a comprehensive and up-to-date review on the latest hypotheses explaining the pathogenetic relationship between celiac disease and liver injury. Besides the involvement of gut–liver axis, tissue transglutaminase antibodies, and impairment of intestinal barrier, we integrate the latest achievements made in elucidation of the role of gut microbiota in celiac disease and liver disorders, that has not yet been sufficiently discussed in the literature in this context. The further objective is to provide a complete clinical overview on the types of liver diseases frequently found in celiac disease. In conclusion, the review highlights the clinical implication, recommend a rational approach for managing elevated transaminases in celiac patients, and underscore the importance of screening for celiac disease in patients with associated liver disease.
Highlights
The liver is an organ playing a regulatory role in innate and adaptive immunity
All types of liver cells, including resident immune cells, hepatocytes, cholangiocytes, sinusoidal endothelial cells, and hepatic stellate cells express a range of pattern recognition receptors (PRRs), such as toll-like receptors (TLRs), NOD-like receptors (NLRs), RIG-like receptors, carbohydrate receptors, and scavenger receptors, which bind to microbial-associated molecular patterns (MAMPs) and damage-associated molecular patterns (DAMPs) that may be present in portal blood
The liver is a highly immunologically active organ that must simultaneously induce and maintain tolerance while being able to trigger immune responses leading to both protective immunity as well as liver inflammation and fibrosis
Summary
The liver is an organ playing a regulatory role in innate and adaptive immunity. Constituents in portal blood circulating from the intestine to the liver, such as food antigens (including peptides derived from gluten and related cereals), bacterial components and products, can under specific conditions (e.g., impaired intestinal barrier and/or dysregulation of gut–liver axis) trigger the hepatic immune response, which is connected to liver inflammation and fibrosis. Immunologically mediated liver diseases are the most common extraintestinal manifestations of celiac disease [1,2,3,4,5,6,7,8], there are still many scientific and clinical question to be answered This narrative review attempts to summarize the current status of knowledge regarding (1) the pathogenetic relationship between celiac disease and liver injury, (2) the types of liver diseases frequently found in celiac disease, (3) recommendation for a rational approach for managing elevated transaminases in celiac patients, and (4) vice versa for screening for celiac disease in patients with liver. We included scientific papers regarding liver immunology to emphasize liver as an organ with unique immune function, and to summarize hypotheses explaining connection between celiac diseases and liver disorders. Number of observational studies and meta-analyses were used to document the current clinical approach to the liver disorders in celiac patients
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