TY - JOUR
T1 - Elevated liver enzymes of newly diagnosed pediatric celiac patients—a prospective-observational study
AU - Regev, Asaf
AU - Ben-Tov, Amir
AU - Yerushalmy-Feler, Anat
AU - Weintraub, Yael
AU - Moran-Lev, Hadar
AU - Cohen, Shlomi
AU - Amir, Achiya Z.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/2
Y1 - 2022/2
N2 - 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. We conducted a prospective-observational study of all newly diagnosed pediatric celiac patients, between August 2016 and April 2018, in a pediatric gastroenterology clinic. Clinical data, anthropometrics, and blood test results were recorded at diagnosis and at 3, 6, and 12 months, respectively, of follow-up. We compared patients with normal and elevated transaminases at diagnosis. ALT threshold was set at 24 U/l. Of 125 newly diagnosed celiac patients, 31 (24.8%) had elevated ALT at diagnosis; two (1.6%) with over 3 × ULN. 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). Eighty percent of patients with elevated ALT levels normalized their ALT within 3 months and all within 1 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 1-year follow-up. A single patient was simultaneously co-diagnosed with celiac disease and autoimmune hepatitis. Conclusion: Clinically significant ALT abnormalities are rare among newly diagnosed pediatric celiac patients. Significant elevations failing to normalize on a gluten-free diet should raise concern of a concomitant primary liver disease and warrant further investigations.What is Known:• Elevated liver enzymes may be an extra-intestinal manifestation of celiac disease.• Reported prevalences of ALT elevations among children with a new diagnosis of celiac disease ranges between 5 and 40%.What is New:• ALT elevations are present in 25% of children with a new diagnosis of celiac disease.• Significant elevations (>3 × ULN) are rare (1.6%).• Elevated liver enzymes are associated with earlier age at diagnosis.• The natural history of patients with elevated liver enzymes at diagnosis is comparable to those without.
AB - 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. We conducted a prospective-observational study of all newly diagnosed pediatric celiac patients, between August 2016 and April 2018, in a pediatric gastroenterology clinic. Clinical data, anthropometrics, and blood test results were recorded at diagnosis and at 3, 6, and 12 months, respectively, of follow-up. We compared patients with normal and elevated transaminases at diagnosis. ALT threshold was set at 24 U/l. Of 125 newly diagnosed celiac patients, 31 (24.8%) had elevated ALT at diagnosis; two (1.6%) with over 3 × ULN. 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). Eighty percent of patients with elevated ALT levels normalized their ALT within 3 months and all within 1 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 1-year follow-up. A single patient was simultaneously co-diagnosed with celiac disease and autoimmune hepatitis. Conclusion: Clinically significant ALT abnormalities are rare among newly diagnosed pediatric celiac patients. Significant elevations failing to normalize on a gluten-free diet should raise concern of a concomitant primary liver disease and warrant further investigations.What is Known:• Elevated liver enzymes may be an extra-intestinal manifestation of celiac disease.• Reported prevalences of ALT elevations among children with a new diagnosis of celiac disease ranges between 5 and 40%.What is New:• ALT elevations are present in 25% of children with a new diagnosis of celiac disease.• Significant elevations (>3 × ULN) are rare (1.6%).• Elevated liver enzymes are associated with earlier age at diagnosis.• The natural history of patients with elevated liver enzymes at diagnosis is comparable to those without.
KW - Celiac disease
KW - Children
KW - Elevated liver enzymes
KW - Hypertransaminasemia
UR - http://www.scopus.com/inward/record.url?scp=85119157956&partnerID=8YFLogxK
U2 - 10.1007/s00431-021-04259-w
DO - 10.1007/s00431-021-04259-w
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C2 - 34586475
AN - SCOPUS:85119157956
SN - 0340-6199
VL - 181
SP - 753
EP - 762
JO - European Journal of Pediatrics
JF - European Journal of Pediatrics
IS - 2
ER -