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. Address correspondence and reprint requests to Samuele Naviglio, MD, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Via dell'Istria 65/1, 34137, Trieste, Italy (e-mail: samuele.naviglio@gmail.com). Received 18 August, 2018 Accepted 5 November, 2018 Elisa Benelli and Samuele Naviglio contributed equally to this work. Conflicts of Interest and Source of Funding: This study was supported by the European Union - European Regional Development Fund (Interreg Central Europe "Focus in CD" project N° CE11). All Authors declare no conflict of interests. © 2018 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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