An Investigation of Celiac Disease Severity in Patients Presenting with Elevated Liver Enzymes

Introduction: Celiac disease (CD) is well known to affect the liver. An association between CD and liver damage was first described in 1977 when it was noted that 40% of adults with CD had increased transaminases. Since then, further studies have evaluated liver involvement in CD patients. To date, few studies have examined the clinical course and disease severity of adult CD patients who initially presented with elevated liver function tests (LFTs) and were subsequently diagnosed with CD. Addressing this question may help prognosticate future CD patients presenting with LFT abnormalities. Methods: This is a single center retrospective chart review study at Thomas Jefferson University Hospital. CD severity was measured by histology (Marsh classification), laboratory data (transglutaminase (TTG) IgA antibodies), and time to mucosal healing. Patients with elevated LFTs (eLFT) on presentation were compared to a control group of patients with normal LFTs. Patients without an initial Marsh classification and those with known liver disease and alcohol abuse disorder were excluded. Comparison of CD disease severity was measured using descriptive statistics. Results: A total of 410 patient charts were reviewed, of which 293 patients were included. Of this group, 18 patients were found to have elevated LFTs on presentation. Notably five of these patients solely presented with elevated LFTs. The remaining 275 patients with normal LFTs on presentation served as control. Mean age for presentation of eLFT cohort was 39.4 years and 42.4 years in the control group. Patients had similar BMI (26.9 kg/m2 for eLFT group vs 26.4 kg/m2 in the control group) and similar hemoglobin (13.3 g/dL for eLFT group vs 13.5 g/dL in the control group). Patients in the eLFT cohort presented with more severe Marsh score compared to control (77.8% in eLFT group had Marsh 3A or greater vs 61.1% in the control group). Patients eLFT group also presented with higher TTG IgA (47.1 U/mL in eLFT vs 37.8 U/mL in the control group). Interestingly, in patients who presented solely with eLFTs (n=5), 100% presented with Marsh 3A or greater and had a mean TTG IgA of 74.4 U/mL. Time to mucosal healing was longer in the eLFT cohort (47.5 months in eLFT vs 28.6 months in the control group). Conclusion: CD patients with elevated LFTs on initial presentation were found have more severe disease based on worse Marsh classification and higher mean TTG IgA antibodies. Future investigation is needed to understand the underlying mechanism for this process.Table 1.: Demographics and disease severity in CD patients with and without elevated LFTs at time of initial presentation