celiac hepatitis
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Mildly elevated liver enzymes with no other explanation — a common, usually reversible liver finding in celiac disease.
Celiac hepatitis refers to the hepatic (liver) manifestation of celiac disease: a pattern of mildly elevated liver transaminases (ALT and AST) in a celiac patient where no other liver condition is present. It is one of the most common extraintestinal manifestations and is an important reason why unexplained elevated liver enzymes should prompt celiac testing.
Mechanism
The liver connection in celiac has two likely drivers:
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Increased intestinal permeability — a "leaky gut" (disrupted tight junctions) allows bacterial products and antigens from the gut to enter the portal circulation and reach the liver, triggering low-grade hepatic inflammation
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Anti-tTG antibody deposition — tissue-transglutaminase is expressed in hepatic stellate cells; anti-tTG IgA deposits may cause localised immune-mediated damage
Distinguishing Features
- Transaminase elevation is mild (typically 1–3× upper limit of normal)
- No other cause found — viral hepatitis, alcohol, medications, metabolic liver disease all excluded
- No symptoms — usually an incidental finding on blood tests
- Resolves on GFD — this is the hallmark; normalisation of liver enzymes after starting GFD strongly supports celiac hepatitis as the cause
When It Matters
Persistently raised liver enzymes with no identified cause (cryptogenic hepatitis) should prompt celiac testing — this is included in NICE guidelines as a "consider testing" indication.
Importantly, celiac hepatitis must be distinguished from more serious liver involvement:
- Autoimmune hepatitis — a separate autoimmune liver disease with higher transaminases, different antibody profile; can coexist with celiac (shared autoimmune predisposition)
- Primary biliary cholangitis (PBC) — another autoimmune liver disease with celiac comorbidity
- Non-alcoholic fatty liver disease — a GFD-related dietary change complication (GF substitutes are high in fat/sugar)
Related Concepts
autoantibodies-celiac | tissue-transglutaminase | tight-junctions | gluten-free-diet | symptoms