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Abstract
Background. Liver involvement in celiac disease (CD) is clinically relevant and could require specific treatment in addition to gluten-free diet (GFD). Transient elastography (TE), a noninvasive tool for assessing liver stiffness (LS), has widely been reported as an accurate surrogate marker of liver fibrosis. Aims. To prospectively identify celiac patients with liver involvement by TE and to assess the effect of GFD. Material and methods. Ninety-five histologically confirmed CD patients (24 newly diagnosed) were consecutively evaluated by TE and compared with 146 patients with chronic hepatitis C (HCV) and 54 healthy subjects. Results. LS ranged between 2.8 and 6.7 kPa (median 4.9) in healthy subjects, defining 6.9 kPa as the upper reference limit (2 SD above the mean levels). TE was above 6.9 kPa in 10 (10.5%) CD patients. Median TE values resulted significantly higher in CD patients with hypertransaminasemia than those without [6.1 vs. 4.2 kPa (p < 0.01)]. Among the 24 newly diagnosed patients with CD, median TE values declined from 4.4 to 4 kPa, after 6 months of GFD, resulting below 6.9 kPa in 100% of the patients. Conclusions. A subset of CD patients with hypertransaminasemia showed liver involvement by TE. Accordingly, based on its accuracy in predicting liver fibrosis, TE could be used to identify those CD patients suitable for liver biopsy.
Acknowledgement
Sara Massironi and Roberta Elisa Rossi designed and wrote the paper and subsequently revised it critically, contributing equally to this work; Mirella Fraquelli and Sara Massironi contributed to acquisition of data; Serena Della Valle and Matilde Pia Spampatti performed literature research; Marco Maggioni contributed to acquisition of data and their interpretation; Maria Teresa Bardella and Luca Elli revised the paper critically for important intellectual contents; Dario Conte and Massimo Colombo corrected the final version of the manuscript. Finally, all the authors approved it.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.