As many as 1 in 100 Americans may be affected by celiac disease, a condition that stems from an inappropriate immune response to dietary gluten. If you have celiac disease, eating foods that contain gluten -- wheat, barley, rye and related grains -- leads to inflammation of your intestinal lining, malabsorption of various nutrients and a constellation of other health problems, including liver damage. A gluten-free diet can reverse some, but not all, liver manifestations of celiac disease.
Mechanism
Gluten is a protein that is relatively resistant to digestion. Large molecular fragments arising from the breakdown of gluten are absorbed by the cells lining your intestine, whereupon they trigger an immune response in people who are genetically predisposed to celiac disease. This immune response spreads beyond your gastrointestinal tract to involve multiple organs, including your skin, bones, reproductive system, nervous system, endocrine glands and liver. According to the May 2008 issue of "Clinical Reviews in Allergy and Immunology," liver injury resulting from celiac disease spans a broad spectrum, but two main forms -- cryptogenic hepatitis and autoimmune hepatitis -- are most commonly seen.
Cryptogenic
Cryptogenic liver disease is is liver damage whose origin is unknown. Many cases of celiac-caused liver disease are called cryptogenic, because the abnormalities in liver function are often discovered before celiac disease is diagnosed. The initial manifestation of cryptogenic liver injury is usually an elevation in your liver enzymes, which is often discovered incidentally during routine blood tests. Sometimes this type of injury has progressed to liver scarring before it is discovered. However, this type of celiac hepatitis, even when severe, is reversible after institution of a gluten-free diet.
Autoimmune
Another form of liver damage associated with celiac disease -- autoimmune hepatitis -- presents somewhat differently from cryptogenic hepatitis, although the two conditions may simply represent different forms of the same condition in people with different genetic backgrounds. A November 2007 review in the Spanish journal "Revista Española de Enfermedades Digestivas" reports that autoimmune hepatitis caused by celiac disease, unlike celiac-associated cryptogenic hepatitis, does not improve on a gluten-free diet. Liver biopsy and blood tests for specific antibodies can help to distinguish between autoimmune hepatitis and cryptogenic hepatitis.
Considerations
Celiac disease is commonly associated with liver damage. More than half of untreated celiac patients exhibit elevated liver enzymes, and 5 to 10 percent have persistently high enzymes even after adopting a gluten-free diet. Cryptogenic and autoimmune hepatitis may represent different manifestations of the same condition in those with different genetic susceptibilities. While cryptogenic hepatitis -- even when severe -- is reversible with a gluten-free diet, autoimmune hepatitis does not respond to dietary changes. However, a gluten-free diet helps to reduce intestinal inflammation and improve nutrient absorption in all celiac patients.
References
- "American Family Physician"; Celiac Disease; R.J. Presutti, et al.; December 2007
- "Clinical Reviews in Allergy and Immunology"; Pathogenesis and Clinical Significance of Liver Injury in Celiac Disease; U. Volta; May 2008
- "Revista Española de Enfermedades Digestivas"; Liver Damage and Celiac Disease; M.D. Cantarero Vallejo, et al.; November 2007
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