Abstract
Celiac disease clinical presentation is constantly changing. We set to determine the prevalence of elevated transaminases in newly diagnosed celiac patients and to evaluate this sub-group of patients for associated clinical and laboratory findings and assess their natural course of disease following therapeutic diet initiation. We conducted a prospective-observational study of all newly diagnosed pediatric celiac patients, between August 2016 and April 2018, in a pediatric gastroenterology clinic. Clinical data, anthropometrics, and blood test results were recorded at diagnosis and at 3, 6, and 12months, respectively, of follow-up. We compared patients with normal and elevated transaminases at diagnosis. ALT threshold was set at 24 U/l. Of 125 newly diagnosed celiac patients, 31 (24.8%) had elevated ALT at diagnosis; two (1.6%) with over 3 × ULN. Patients with elevated ALT at diagnosis were significantly younger (mean age 5.5 (SD 3.4) vs. 7.3 (SD 3.7) years, p < 0.01) and more commonly presented with diarrhea (32.3% vs. 14.9%, p = 0.03). Eighty percent of patients with elevated ALT levels normalized their ALT within 3months and all within 1year. Following gluten-free diet initiation, patients with elevated ALT had similar clinical course, growth, serology normalization rate, and laboratory results, compared to patients with normal ALT over a 1-year follow-up. A single patient was simultaneously co-diagnosed with celiac disease and autoimmune hepatitis.Conclusion: Clinically significant ALT abnormalities are rare among newly diagnosed pediatric celiac patients. Significant elevations failing to normalize on a gluten-free diet should raise concern of a concomitant primary liver disease and warrant further investigations. What is Known: • Elevated liver enzymes may be an extra-intestinal manifestation of celiac disease. • Reported prevalences of ALT elevations among children with a new diagnosis of celiac disease ranges between 5 and 40%. What is New: • ALT elevations are present in 25% of children with a new diagnosis of celiac disease. • Significant elevations (>3 × ULN) are rare (1.6%). • Elevated liver enzymes are associated with earlier age at diagnosis. • The natural history of patients with elevated liver enzymes at diagnosis is comparable to those without.
Highlights
Celiac disease (CD) is an autoimmune disorder, affecting mainly the intestinal mucosa
Patients with elevated ALT at diagnosis were significantly younger (mean age 5.5 (SD- 3.4) vs 7.3 (SD- 3.7) years, p < 0.01) and more commonly presented with diarrhea (32.3% vs. 14.9%, p = 0.03). 80% of patients with elevated ALT levels, normalized their ALT within 3 months and all within one year
A single patient was simultaneously co-diagnosed with celiac disease and auto-immune hepatitis
Summary
Celiac disease (CD) is an autoimmune disorder, affecting mainly the intestinal mucosa. Inflammation is mediated by auto-antibodies, generated in genetically susceptible individuals, following intestinal exposure to gluten or related proteins abundant in one of the three main cereals used by man: wheat, barley and rye [1]. The disorder is common with a prevalence of up to 1 percent in the general population [2,3,4]. CD classical presentation of severe and prolonged diarrhea, weight loss, wasting and abdominal distention is rare nowadays [5]. Celiac patients present with non-specific abdominal symptoms, extra intestinal manifestations and occasionally patients are asymptomatic altogether and are diagnosed following screening [6]. Extra-intestinal manifestations may include malabsorption and related disorders, impaired growth and weight gain, fatigue, skin rash and liver involvement [7]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have