title: Pediatric celiac disease, cryptogenic hypertransaminasemia, and autoimmune hepatitis.
abstract: OBJECTIVE
  The association between celiac disease (CD) and liver disease in pediatrics is widely recognized, but its prevalence is unknown. This study aims to conduct a systematic review and meta-analysis to evaluate the prevalence of CD in children with cryptogenic persistent hypertransaminasemia (HTS) or autoimmune hepatitis (AIH), and vice versa.
  
  
  METHODS
  We searched MEDLINE/PubMed, the Cochrane Library, Web of Science, and MD Consult from 1977 to May 2012 for studies reporting either CD and HTS or AIH. Pooled prevalences with 95% confidence intervals (CI) and relative risk (RR) were calculated.
  
  
  RESULTS
  Nine studies (2046 patients) were identified. Pooled prevalences of CD in children with mild, nonspecific cryptogenic persistent HTS and vice versa were 12.0% (95% CI 4.17-29.96) and 36.0% (95% CI 32.15-40.11), respectively. A gluten-free diet normalized transaminase levels in 77% to 100% of patients with CD within 4 to 8 months. Pooled prevalences of CD in children with AIH and vice versa were 6.3% (95% CI 3.87-11.73) and 1.4% (95% CI 0.84-2.15), respectively. The RR of HTS in children with CD versus the general population, and of CD in children with HTS was 6.55 (95% CI 5.65-7.60) and 11.59 (95% CI 3.80-35.33), respectively. The corresponding RR of AIH in children with CD was 188.54 (95% CI 92.23-385.43). The RR of CD in children with AIH was 6.63 (95% CI 3.86-11.40).
  
  
  CONCLUSIONS
  CD is associated with elevated transaminase levels in about one-third of newly diagnosed children. Cryptogenic persistent HTS may signal gluten-dependent nonspecific mild hepatitis (12.0% of cases) or more rarely (6.3%) severe CD-related autoimmune hepatopathy. RRs confirm these trends in the considered associations.
authors: Department of Pediatrics, School of Medicine at the University of Salerno, Salerno, Italy. pvajro@unisa.it
authors: Pietro
authors: P
authors: Vajro
authors: Giulia
authors: G
authors: Paolella
authors: Giuseppe
authors: G
authors: Maggiore
authors: Giuseppe
authors: G
authors: Giordano
mesh_terms: D000293:Adolescent; D002446:Celiac Disease / Q000097:blood / Q000178:diet therapy / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D055050:Diet, Gluten-Free; D006505:Hepatitis / Q000097:blood / Q000201:enzymology / Q000453:epidemiology* / Q000503:physiopathology; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D006521:Hepatitis, Chronic / Q000097:blood / Q000201:enzymology / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000097:blood / Q000151:congenital / Q000201:enzymology / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D012720:Severity of Illness Index; D000637:Transaminases / Q000097:blood
chemical_list: D000637:Transaminases