title: The liver in celiac disease: clinical manifestations, histologic features, and response to gluten-free diet in 30 patients.
abstract: Descriptive reports of liver histologic features in celiac disease (CD) are sparse, and the effect of a gluten-free diet (GFD) on the course of liver injury is poorly understood. We reviewed liver biopsy specimens in 30 patients with CD and performed immunostains for IgG, IgG4, IgM, and IgA. Subsequent liver biochemical tests and compliance with the GFD were recorded. Of the patients, 19 had autoimmune-mediated liver disease (AILD; autoimmune hepatitis, 9; primary sclerosing cholangitis, 7; and primary biliary cirrhosis, 3). The remaining 11 patients had cryptogenic hepatitis (5), hepatitis C (2), steatohepatitis (2), sarcoidosis (1), and T-cell lymphoma (1). The liver disease diagnosis preceded the CD diagnosis in all groups except steatohepatitis. Although 82% of patients without AILD had symptomatic CD, only 26% of patients with AILD had such symptoms. The pathology of the specific liver disease was not atypical in histologic features or IgG/IgM ratios. While GFD improved cryptogenic hepatitis, it did not seem to affect AILD. We propose that AILD and cryptogenic hepatitis in patients with CD represent distinct clinical, histologic, and immunohistochemical entities rather than 2 ends of a spectrum of liver injury.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA. Mounajjed.Taofic@mayo.edu
authors.forename: Taofic
authors.initials: T
authors.lastname: Mounajjed
authors.forename: Amy
authors.initials: A
authors.lastname: Oxentenko
authors.forename: Eugenia
authors.initials: E
authors.lastname: Shmidt
authors.forename: Thomas
authors.initials: T
authors.lastname: Smyrk
mesh_terms: D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000178:diet therapy / Q000473:pathology*; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome