TOPLINE:
Patients with celiac disease have a twofold higher risk for developing any chronic liver disease than the general population, with the risk remaining elevated beyond 25 years after diagnosis.
METHODOLOGY:
- A recent meta-analysis reported that approximately one fifth of patients with celiac disease have elevated aminotransferase levels, potentially signaling underlying liver injury or risk for chronic liver disease.
- Researchers conducted this nationwide population-based cohort study in Sweden to assess the long-term risk for chronic liver disease in 48,027 patients with biopsy-confirmed celiac disease (median age at diagnosis, 27.3 years; 62.7% women) between 1969 and 2017; the patients were matched with 231,909 reference individuals from the general population.
- The primary outcome was any incident chronic liver disease; secondary outcomes included specific liver conditions, such as viral hepatitis, metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease, and autoimmune liver disease, and major adverse liver outcomes (MALOs).
- To further confirm the findings, a sibling comparison was conducted between 31,176 patients with celiac disease and their 52,999 siblings without the condition.
TAKEAWAY:
- After a median follow-up of 16 years, the incidence rate of any chronic liver disease was 79.4 vs 39.5 per 100,000 patient years in those with celiac disease compared with reference individuals, respectively.
- Compared with reference individuals, patients with celiac disease had an increased risk for any chronic liver disease (adjusted hazard ratio [aHR], 2.01); the risk remained elevated for at least 25 years after diagnosis of celiac disease.
- This risk was further worsened with a history of autoimmune (aHR, 4.30) or metabolic-related (aHR, 3.81) diseases.
- Patients with celiac disease had elevated risks for autoimmune liver disease (aHR, 4.86), MASLD (aHR, 2.54), alcohol-related liver disease (aHR, 1.51), and MALO events (aHR, 1.54).
- Patients with celiac disease had higher risks for any chronic liver disease and MALO events than their siblings without celiac disease.
IN PRACTICE:
“[This study] has provided solid background for implementing the care of patients with [celiac disease] developing liver function test abnormalities, but also constitutes a salutary lesson because it stresses the importance of screening for [celiac disease] individuals presenting with cryptic hypertransaminasemia,” experts wrote in an accompanying editorial.
SOURCE:
This study was led by Jialu Yao, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. It was published online in The Lancet Regional Health – Europe.
LIMITATIONS:
This study included only patients diagnosed through histopathology, potentially missing those diagnosed through serology. The lack of data on primary care and incomplete coverage of specialist care may have led to underestimation of milder cases of chronic liver disease, particularly MASLD. Causality could not be established due to the observational nature of this study. The absence of specific diagnostic codes and data on nutritional status prevented differentiation between malnutrition-associated SLD and MASLD.
DISCLOSURES:
This study received support from the European Crohn’s and Colitis Organisation, the Swedish Society for Medical Research, FORTE, Takeda Pharmaceuticals, and the Swiss National Science Foundation. One author reported being an employee of Takeda Pharmaceuticals. Several authors reported serving on advisory boards and committees, receiving research funds, and having other ties with various pharmaceutical companies including Takeda Pharmaceuticals.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.