Is coeliac disease a potentially treatable cause of liver failure?

Hypertransaminasaemia occurs in up to 40% of patients with coeliac disease and resolves with a gluten-free diet. Chronic liver disease such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and chronic autoimmune hepatitis is associated with coeliac disease. Coeliac disease is up to 10 times more frequent among patients with chronic liver disease than the general population. Increased intestinal permeability, small intestinal bacterial overgrowth, Kupffer cell abnormalities, direct toxicity of gliadin peptides, or a gliadin-stimulated immunopathological process may have a role to play in the progression of chronic liver disease among coeliac patients. The institution of a gluten-free diet leads to an improvement in those patients with liver failure and previously undiagnosed coeliac disease. Hypertransaminasaemia is a common abnormality found in up to 40% of untreated coeliac patients, which resolves with the institution of a gluten-free diet. A much rarer occurrence is the association of chronic liver disease with coeliac disease. Primary biliary cirrhosis, primary sclerosing cholangitis, and chronic autoimmune hepatitis have all been recognized in coeliac patients. More recently, the occurrence of coeliac disease in patients with chronic liver disease is found to be 10 times greater than that in the general population. Of particular note are the 13 patients reported to date with liver failure and coeliac disease. Among those patients commenced on a gluten-free diet an improvement in liver function was observed. The relationship between coeliac disease, a gluten-free diet, and the course of chronic liver disease needs to be clarified.