GLUTEN-SENSITIVE ENTEROPATHY – A POTENTIALLY CURABLE CAUSE OF HEPATIC DISORDERS
Journal of IMAB
The clinical spectrum of gluten-sensitive enteropathy is remarkably varied and the disease can affect many extraintestinal organs and systems, including the liver. Liver involvement, which is observed in patients with gluten-sensitive enteropathy, varies from an asymptomatic increase of hepatic enzymes or non-specific reactive hepatitis (cryptogenic hepatic disorders) to chronic liver disease. The histological changes and the dynamics of enzymes are notably different after a glutenfree diet
... glutenfree diet (GFD) treatment. Patients and Methods: A clinical observation included 112 patients with gluten-sensitive enteropathy and 22 patients with gluten sensitivity, who passed through the Clinic of Gastroenterology, Hepatology and Nutrition at St. Marina University Hospital, Varna for the period from January, 2005 to June, 2015. Thirty-four men and 78 women between the ages of 18 and 76 were included. The control group consisted of 22 patients of whom 6 were men and 16 -women. Results and Discussion: Patients with proven hepatic diseases with autoimmune or viral genesis were excluded from the group participating in the current study. The observation and study were conducted on 8 patients -3 men and 5 women put on a GFD for a period of 6 months. All 8 patients were with abnormal hepatic enzyme levels. The median levels (±SD) of ASAT and ALAT were 62.6 ± 16.5 IU/mL with a range of 31-186 IU/mL, and 69.3 ± 9.3 IU/mL and a range of 63-432 IU/mL, respectively. The median concentrations of alkaline phosphatase were ± 280.3±118.7 mmol/L (range -160-428 mmol/L). Six months after GFD, the hepatic enzyme levels decreased to a level of 24.5± 5.1 IU/mL in all patients. Hepatic abnormalities varying from mild changes of hepatic enzyme levels to liver failure at the time of diagnosis could be treated with GFD. Its effect on the severity of other hepatic diseases, for example autoimmune hepatitis, is not clear yet. Regardless of the effect on the concomitant hepatic diseases, GFD is needed for the improvement of the symptoms of gluten-sensitive enteropathy and all long-term consequences. The lack of sufficient amount of proof does not undermine the fact that clinicians should consider the diagnosis -gluten-sensitive enteropathy -when hypertransaminasemia is observed without the presence of other causes of liver dysfunction. order to establish the GE incidence in the different hepatic  diseases and to prove the possible link between them. An early diagnosis and GFD therapy might lead to slowing down or stopping the progress of the hepatic disease.