Hepato-biliary abnormalities in adult celiac sprue: Systematic evaluation of 1095 cases with meta-analysis

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Objective: Celiac sprue (CS) is gluten-induced immunogenic systemic disease. Besides involvement of the small bowel it can have extraintestinal manifestations. Hepato-biiiarÿ abnormalities (HBA) in CS have been reported. We report a case of CS who presented with HBA. We reviewed the literature on this subject and performed qualitative meta-analysis (QMA) on these cases. Methods: A 20 year old man of Norwegian descent was found to have CS and developed liver test abnormalities. He was diagnosed to have celiac hepatitis (transaminitis). On gluten-free diet (GFD) for 9 months his small bowel histology became normal and the liver tests normalized. We did a PubMed search using the terms celiac sprue, celiac disease, gluten-sensitive enteropathy and hepatobiliary abnormality, without any time or language barrier. Only biopsy-proven adult patients with CS were evaluated in this meta-analysis. QMA was performed using the well-established methods of qualitative research. Results: This search yielded 1095 cases of CS who had HBA. Information about gender was available in 384/1095 (35%) of cases. There were 142/384 (37%) men and 242/384 (63%) women. The mean age was 47 (Range 16-91) years. The HBA observed in these patients included celiac hepatitis (reactive hepatitis), primary biliary cirrhosis, primary sclerosing cholangitis, auto-immune hepatitis, non-alcoholic fatty liver, non-alcoholic steatohepatitis and gall-bladder Inertia. Some cases of CS who developed small bowel cancer or lymphoma developed liver test abnormalities due to liver metastasis. GFD had a beneficial effect in many of these cases. GFD should be tried even in those CS cases who have advanced liver disease; liver test abnormality may reverse in some of these cases. Conclusions: PubMed search yielded 1095 cases of CS who had HBA. Patients with unexplained liver test abnormalities should be screened for CS. The institution of GFD in these cases may reverse the liver test abnormality.

Original languageEnglish (US)
Pages (from-to)299-303
Number of pages5
JournalInternational Medical Journal
Issue number3
StatePublished - 2014


  • Celiac hepatitis
  • Celiac sprue
  • Fatty liver
  • Gall-bladder inertia
  • Gluten-free diet
  • Liver test abnormalities
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis

ASJC Scopus subject areas

  • Medicine(all)


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