title: Prevalence of abnormal liver function tests in celiac disease and the effect of a gluten-free diet in the US population.
abstract: OBJECTIVE
  Guidelines recommend routine screening of liver function tests (LFTs) in patients diagnosed with celiac disease (CD). However, little is known about the prevalence of liver disorders in CD outside of Europe. Our aims were to estimate the prevalence of LFT abnormalities in CD and to evaluate the effect of a gluten-free diet (GFD) on LFTs.
  
  
  METHODS
  Adult patients with biopsy-proven CD were identified from a prospectively maintained database and matched with healthy controls. LFT levels for women and men were defined as abnormal based on the Third National Health and Nutrition Examination Survey (NHANES III) criteria. Data on demographics, coexisting liver diseases, and laboratory work-ups including aspartate transaminase (AST) and alanine transaminase (ALT) values at the time of diagnosis and on a GFD were recorded. Subsequently, data from this cohort were compared with data from 7,789 individuals participating in the National Health and Nutrition Examination Survey, 2009-2010. Univariate logistic regression, Wilcoxon signed-ranks, Student's t-test, χ(2), and Fischer's exact test were used for statistical analysis.
  
  
  RESULTS
  In 463 CD patients with ALT or AST levels at the time of CD diagnosis, 40.6% had elevated LFTs compared with 24.2% of treated CD patients (P<0.001) and 16.6% of matched controls (P<0.001). Similarly, 36.7% of CD patients on the NHANES database had abnormal ALT values compared with 19.3% of non-celiac patients (P=0.03). Approximately, 78.6% of CD patients with elevated LFTs at diagnosis normalized LFTs on a GFD after a mean duration of 1.5±1.5 years.
  
  
  CONCLUSIONS
  Forty percent of individuals will have elevated LFTs at CD diagnosis; however, the majority will normalize with standard CD therapy. LFTs should be checked in all patients with CD and coexisting liver disorder should be considered in patients whose LFTs have not improved within a year on a GFD.
authors.affiliation: 1] Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA [2] Joint first authors.
authors.forename: Natalia E
authors.initials: NE
authors.lastname: Castillo
authors.affiliation: 1] Department of Medicine and Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA [2] Joint first authors.
authors.forename: Rohini R
authors.initials: RR
authors.lastname: Vanga
authors.affiliation: Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Thimmaiah G
authors.initials: TG
authors.lastname: Theethira
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.affiliation: Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Villafuerte
authors.affiliation: Liver Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Bonder
authors.affiliation: Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Rupa
authors.initials: R
authors.lastname: Mukherjee
authors.affiliation: Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Hansen
authors.affiliation: Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Melinda
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Ciaran P
authors.initials: CP
authors.lastname: Kelly
authors.affiliation: Celiac Center, Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Leffler
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D016022:Case-Control Studies; D002446:Celiac Disease / Q000178:diet therapy* / Q000201:enzymology*; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012189:Retrospective Studies; D014481:United States
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase