title: Gluten-sensitive hypertransaminasemia in celiac disease: an infrequent and often subclinical finding.
abstract: OBJECTIVE
  Earlier studies suggest that 40-50% of untreated celiac disease patients have elevated transaminase levels. Celiac disease can also be the underlying reason for unexplained hypertransaminasemia or even liver failure. We investigated the prevalence and gluten dependency of hypertransaminasemia in celiac patients also diagnosed with minor or atypical symptoms.
  
  
  METHODS
  In the cross-sectional study, serum aspartate (AST) and alanine (ALT) transaminase levels were measured in 313 untreated and 339 treated adult celiac patients and 237 non-celiac controls. In the prospective part, transaminase levels were investigated in 130 celiac patients at diagnosis and after 1 year on a gluten-free diet and in 25 treated celiac patients in clinical remission before and after gluten challenge.
  
  
  RESULTS
  The proportion of subjects with elevated serum AST values in the untreated celiac disease group (11%) did not differ significantly from that in the treated celiac disease (8%) or non-celiac control groups (9%) (P=0.587). Although the serum transaminase values were within normal range in the majority of untreated patients, initially normal liver enzyme levels decreased significantly on a gluten-free diet. In treated celiac disease, gluten challenge led to mild and transient hypertransaminasemia.
  
  
  CONCLUSIONS
  In our area, where the prevalence of celiac disease is high, hypertransaminasemia is less frequent in untreated celiac disease patients than previously reported. The regular screening of transaminases in celiac disease needs to be re-evaluated. Although the liver enzyme levels were within the reference values in the majority of celiac patients, an obvious gluten dependence of transaminase levels was observed even in these subjects.
authors.affiliation: Pediatric Research Center, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Korpimäki
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Haapala
authors.forename: Päivi
authors.initials: P
authors.lastname: Holm
authors.forename: Kaija
authors.initials: K
authors.lastname: Laurila
authors.forename: Kalle
authors.initials: K
authors.lastname: Kurppa
authors.forename: Päivi
authors.initials: P
authors.lastname: Saavalainen
authors.forename: Katri
authors.initials: K
authors.lastname: Haimila
authors.forename: Jukka
authors.initials: J
authors.lastname: Partanen
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Marja-Leena
authors.initials: ML
authors.lastname: Lähdeaho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood* / Q000187:drug effects; D001219:Aspartate Aminotransferases / Q000097:blood* / Q000187:drug effects; D002446:Celiac Disease / Q000178:diet therapy / Q000201:enzymology* / Q000473:pathology; D003430:Cross-Sectional Studies; D055050:Diet, Gluten-Free; D005260:Female; D005983:Glutens / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D005983:Glutens; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase