Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.776
Peer-review started: September 28, 2016
First decision: November 9, 2016
Revised: November 28, 2016
Accepted: December 8, 2016
Article in press: December 8, 2016
Published online: February 7, 2017
Celiac disease (CD) is a systemic immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. The typical symptoms are anemia, diarrhea, fatigue, weight loss, and abdominal pain. CD has been reported in patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, aminotransferase elevations, nonalcoholic fatty liver disease, hepatitis B, hepatitis C, portal hypertension and liver cirrhosis. We evaluate recommendations for active screening for CD in patients with liver diseases, and the effect of a gluten-free diet in these different settings. Active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, steatosis in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. In hepatitis C, diagnosis of CD can be important as a relative contraindication to interferon use. Gluten-free diet ameliorates the symptoms associated with CD; however, the associated liver disease may improve, remain the same, or progress.
Core tip: Liver involvement in celiac disease (CD) has been reported for more than four decades. However, CD antibodies are seldom investigated by clinicians in routine hepatology consultations. In this article, we perform extensive literature review on liver and CD and evaluate if one should screen for celiac antibodies in various liver diseases and clinical settings.