title: Factors that contribute to hypertransaminasemia in patients with celiac disease or functional gastrointestinal syndromes.
abstract: OBJECTIVE
  Transaminasemia develops via different pathways in patients with celiac disease; no information is available on risk factors specifically attributable to celiac disease.
  
  
  METHODS
  We analyzed data collected from consecutive patients referred from January 1997 through December 2009 to the celiac disease clinic at the Spedali Civili of Brescia, Italy. We assessed the factors affecting hypertransaminasemia in 683 patients with celiac disease (based on serologic and biopsy analysis, cohort A; 34 ± 14 years of age) and 304 with functional syndromes (cohort B; 37 ± 13 years of age).
  
  
  RESULTS
  Hypertransaminasemia was detected in 138 patients in cohort A (20%). It was associated with malabsorption (odds ratio [OR], 2.22; P = .004), diarrhea (OR, 1.72; P = .005), and increasing severity of mucosal lesion (Marsh-Oberhuber class; OR, 1.46; P = .001) but not with body mass index (BMI) or the serum level of tissue-transglutaminase antibodies (tTG). Hypertransaminasemia was detected in 22 patients in cohort B (7%) and was associated with the World Health Organization's BMI categories (OR, 7.9; P < .001). In subsets of patients studied with the same analytical method (313 of cohort A and 188 of cohort B), the level of tTG was significantly higher in cohort A at baseline (25.2 ± 16.9 U/L aspartate aminotransferase [AST]) than in cohort B (20.6 ± 9.9 U/L AST, P < .0001) and was related to BMI in cohort B (P = .0012) but not cohort A. When patients were placed on gluten-free diets, the levels of AST decreased from 25.2 ± 16.9 U/L to 19.9 ± 6.6 U/L (P < .0001), independently of the changes of duodenal histology and tTG and correlated with BMI (P = .0007); the prevalence of hypertransaminasemia decreased from 13% to 4%.
  
  
  CONCLUSIONS
  Patients with celiac disease have a higher prevalence of hypertransaminasemia than controls (patients with functional syndromes). Hypertransaminasemia is related to the severity of the duodenal lesion and malabsorption but not BMI. By contrast, there was a positive correlation between the levels of AST and BMI in controls; this relationship was restored when patients with celiac disease were placed on gluten-free diets.
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zanini
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Baschè
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Ferraresi
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Marie Graciella
authors.initials: MG
authors.lastname: Pigozzi
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ricci
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanzarotto
authors.affiliation: Histopathology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.affiliation: Gastroenterology Unit, University and Spedali Civili, Piazza Spedali Civili, Brescia, Italy. Electronic address: lanzini@med.unibs.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Lanzini
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D004751:Enteritis / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D000637:Transaminases / Q000097:blood*
chemical_list: D000637:Transaminases
keywords: Associated Diseases; Clinical Presentation; Gluten Allergy; Liver