6391 Liver dysfunction in children with celiac disease- a cross sectional observational study

Objectives Celiac disease is being increasingly recognized as an important etiology for various extraintestinal organ involvement including liver. Hepatic dysfunction could range from asymptomatic liver enzyme elevation to severe liver damage. This study was done to determine the proportion of children with celiac disease manifesting liver dysfunction and to correlate it with the duodenal histopathological changes. Methods Two set of children aged less than 18years attending the Pediatric Gastroenterology and Nutrition Clinic during the period of November 2019 to October 2021 were selected. This included newly diagnosed cases and children already on gluten free diet (GFD) with good compliance for more than 1 year. The clinic database was reviewed to exclude those celiac children with type 1 diabetes and known liver disorders like autoimmune hepatitis and chronic liver disease. A pre structured proforma with parent/patient information leaflet was created and children meeting the criteria were evaluated with history, examination and laboratory investigations which included liver function tests. The case definition for liver dysfunction was taken as elevation in serum transaminases- aspartate aminotransferase(AST) and or alanine aminotransferase(ALT) as follows: Mild: 1.5–3 times the upper normal limit (ULN) Moderate: 3–5 times the upper normal limit Gross: >5 times the upper normal limit or abnormal liver size for age and sex or abnormal ultrasonographic echo texture. Results Out of the 62 subjects included in the study, 30 were newly diagnosed cases and 32 were children on gluten free diet(GFD) with good compliance. Among the 30 newly diagnosed subjects, 10% (n=3) had 1.5–3 times elevated AST, 3.3% (n=1) had more than 5 times elevated AST and 3.3%(n=1) had 3–5 times elevated ALT. Among the 32 subjects on GFD, 3.1%(n=1) had 1.5–3 times elevated AST and rest had normal values. The study revealed that 10% of newly diagnosed subjects experienced mild liver dysfunction, while 3.3% exhibited severe liver dysfunction. In contrast, only 3.1% of subjects on GFD showed mild liver dysfunction as shown in table 1. Marsh duodenal biopsy grading 3c/3b/3a was found in 66.1%, 24.19% and 9.67% respectively. Conclusion Mild hypertransaminesemia is a frequent finding in celiac disease and in remarkable proportion may be the only hepatic manifestation. This should not be a cause of concern as in most cases it normalizes after starting children on gluten free diet. Nevertheless celiac disease is a potential cause for unexplained hypertransaminesimia and a low threshold to screen is a must.