Newly Diagnosed Celiac Patients with and without Elevated Liver Enzymes at Diagnosis Have Similar Clinical Course

Objectives: Celiac disease clinical presentation is constantly changing. We set to determine the prevalence of elevated transaminases in newly diagnosed celiac patients, and to evaluate this sub-group of patients for associated clinical and laboratory findings and assess their natural course of disease following therapeutic diet initiation.

Methods: We conducted a prospective-observational study of all newly-diagnosed pediatric celiac patients, between August 2016 – April 2018, in a pediatric gastroenterology clinic. Clinical data, anthropometrics and blood test results were recorded at diagnosis and at three, six and twelve months of follow-up. We compared patients with normal and elevated transaminases at diagnosis. ALT threshold was set at 24 U/l.

Results: Of 125 newly-diagnosed celiac patients, 31 (24.8%) had elevated ALT at diagnosis; two (1.6%) with over 3xULN. Patients with elevated ALT at diagnosis were significantly younger (mean age 5.5 (SD- 3.4) vs 7.3 (SD- 3.7) years, p<0.01) and more commonly presented with diarrhea (32.3% vs. 14.9%, p=0.03). 80% of patients with elevated ALT levels, normalized their ALT within 3 months and all within one year. Following gluten free diet initiation, patients with elevated ALT had similar clinical course, growth, serology normalization rate, and laboratory results, compared to patients with normal ALT over a one year follow up. A single patient was simultaneously co-diagnosed with celiac disease and auto-immune hepatitis.

Conclusions: Clinically significant ALT abnormalities are rare among newly diagnosed pediatric celiac patients. Significant elevations failing to normalize on gluten free diet, should raise concern of a concomitant primary liver disease and warrant further investigations.