title: Celiac disease-related hepatic injury: Insights into associated conditions and underlying pathomechanisms.
abstract: BACKGROUND
  Celiac disease (CD) is the most common autoimmune enteropathy. Clinical manifestations may range from a typical malabsorption syndrome to several apparently unrelated extra-intestinal symptoms.
  
  
  OBJECTIVE
  Here we specifically focus on the spectrum of CD-related liver disorders and the underlying pathomechanisms.
  
  
  METHODS
  A computer-based search up to August 2015 was completed using appropriate keywords. References from selected papers were also reviewed and used if relevant.
  
  
  RESULTS
  An unexplained hypertransaminasemia with nonspecific histologic hepatic changes is the most common hepatic presentation. CD however can coexist with a number of liver disorders such as Autoimmune Hepatitis, Autoimmune Cholangitis, Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis requiring a specific treatment in addition to gluten-free diet. CD has also been associated with Viral Hepatitis, Fatty Liver, Non-Alcoholic Steatohepatitis and some severe cryptogenic hepatopaties in the liver transplantation list. Pathomechanisms underlying hepatic injury in CD are multiple, appear still not completely defined and may probably co-occur.
  
  
  CONCLUSIONS
  An ever-increasing number of CD-related liver injuries exist, probably representing a continuum of a same disorder where genetic predisposition, timing, and duration of previous gluten exposure might influence the reversibility of liver damage. Evidences, although not conclusive, support therefore testing for CD also in cryptogenic hepatobiliary conditions where the relationship with CD has not yet been fully investigated.
authors.affiliation: Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy. Electronic address: francescamarciano@virgilio.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Marciano
authors.affiliation: Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Naples, Italy. Electronic address: marcella.savoia@unina.it.
authors.forename: Marcella
authors.initials: M
authors.lastname: Savoia
authors.affiliation: Department of Medicine and Surgery, Pediatrics Section, University of Salerno, Baronissi, Italy; ELFID, University of Naples "Federico II", Naples, Italy. Electronic address: pvajro@unisa.it.
authors.forename: Pietro
authors.initials: P
authors.lastname: Vajro
mesh_terms: D001327:Autoimmune Diseases / Q000453:epidemiology / Q000276:immunology; D002446:Celiac Disease / Q000453:epidemiology / Q000276:immunology*; D002761:Cholangitis / Q000453:epidemiology / Q000276:immunology; D015209:Cholangitis, Sclerosing / Q000453:epidemiology / Q000276:immunology; D015897:Comorbidity; D019693:Hepatitis, Autoimmune / Q000453:epidemiology / Q000276:immunology; D006525:Hepatitis, Viral, Human / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000453:epidemiology / Q000276:immunology; D008107:Liver Diseases / Q000201:enzymology / Q000453:epidemiology / Q000276:immunology*; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology / Q000276:immunology
keywords: Celiac disease; Liver injury; Pathogenetic mechanisms