Tolga DÜZENLİ, Alpaslan TANOĞLU

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Çölyak hastalığının karaciğer tutulumları

Çölyak hastalığı (ÇH) buğdaydaki glutene ve arpa, çavdar, yulaf gibi tahıllarda bulunan gluten benzeri diğer tahıl proteinlerine karşı kalıcı intoleransla karekterize, ağırlıklı olarak proksimal ince barsağı etkileyen bir hastalıktır. Bir enteropati olarak bilinmesine rağmen son yıllarda ortaya konulan ve belirginleşen gastrointestinal sistem dışı bulguları ile de kendini göstermektedir. ÇH, karaciğer enzim yüksekliklerinin %6-9’unu oluştururken, ÇH olanlarda ise karaciğer enzimlerindeki yükselme oranı %40’ lara varabilmektedir. ÇH’nda tek bulgu bazen karaciğer enzim yüksekliği olabildiği gibi; birçok karaciğer hastalığı ile ÇH birlikteliği de gösterilmiştir. Bu kapsamda ÇH tanısı konan hastalarda mutlaka karaciğer enzim taraması önerilmektedir. ÇH ilişkili karaciğer bozuklukları kriptojenik hipertransaminazemi ya da çölyak hepatiti ve otoimmün karaciğer hastalıkları olarak iki ana grupta değerlendirilebilir. Bunların yanında birçok karaciğer hastalığı ile de ÇH birlikteliği gösterilmiştir. Bu yazımızda ÇH ile karaciğer enzim yüksekliği ilişkisini inceleyerek, bu hastalıklara yaklaşımı özetlemeyi hedefledik. 
Anahtar Kelimeler:

Çölyak hastalığı; Gluten; karaciğer

Liver manifestations of Celiac disease

Celiac disease (CD) is characterized by persistent intolerance to wheat gluten and other gluten-like proteins found in cereals such as barley, rye, and oats. It predominantly affects the proximal small intestine. Although CD is known as an enteropathy, an increasing number of extraintestinal manifestations have appeared in recent years. Although CD accounts for 6%-9% of elevated hepatic enzymes, hypertransaminasemia can be seen in 40% of CD patients. Although the only finding could be hypertransaminasemia, many liver diseases and CD co-morbidities have also been demonstrated. In this regard, hepatic enzyme screening is recommended for patients diagnosed with CD. CD-related liver disorders may be categorized into two main groups: cryptogenic hypertransaminase/celiac hepatitis and autoimmune liver diseases. In addition, many liver diseases can be associated with CD. In this article, we aimed to summarize the relation between CD and liver enzyme elevation and the approach to treating hypertransaminasemia in CD patients.
Keywords:

Celiac disease; Gluten; liver,

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  • 1. Ludvigsson JF, Leffler DA, Bai JC, Biagi F, Fasano A, Green PH, et al. The Oslo definitions for coeliac disease and related terms. Gut 2013;62(1):43-52.
  • 2. Volta U, De Franceschi L, Lari F, Molinaro N, Zoli M, Bianchi FB. Coeliac disease hidden by cryptogenic hypertransaminasaemia. Lancet 1998;352(9121):26-9.
  • 3. Sainsbury A, Sanders DS, Ford AC. Meta-analysis: coeliac disease and hypertransaminasaemia. Aliment Pharmacol Ther 2011;34(1):33-40.
  • 4. Castillo NE, Vanga RR, Theethira TG, Rubio-Tapia A, Murray JA, Villafuerte J, et al. Prevalence of abnormal liver function tests in celiac disease and the effect of a gluten-free diet in the US population. Am J Gastroenterol 2015;110(8):1216-22.
  • 5. Hagander B, Berg NO, Brandt L, Nordén A, Sjölund K, Stenstam M. Hepatic injury in adult coeliac disease. Lancet 1977;2(8032):270-2.
  • 6. Marciano F, Savoia M, Vajro P. Celiac disease-related hepatic injury: Insights into associated conditions and underlying pathomechanisms. Dig Liver Dis 2016;48(2):112-9.
  • 7. Miele L, Valenza V, La Torre G, Montalto M, Cammarota G, Ricci R, et al. Increased intestinal permeability and tight junction alterations in nonalcoholic fatty liver disease. Hepatology 2009;49:1877-87.
  • 8. Schwabe RF, Seki E, Brenner DA. Toll-like receptor signaling in the liver. Gastroenterology 2006;130(6):1886-900. 9. Korponay-Szabó IR, Halttunen T, Szalai Z, Laurila K, Király R, Kovács JB, et al. In vivo targeting of intestinal and extraintestinal transglutaminase 2 by coeliac autoantibodies. Gut 2004;53(5):641-8.
  • 10. Vajro P, Maiuri L, Coletta S, Vincenzo A, De Auricchio S. Enhanced expression of intercellular adhesion molecule (ICAM) 1 and transferin receptor (TFR) in the hepatocytes of children with atypical celiac disease (CD) presenting as chronic hepatitis. J Pediatr Gastroenterol Nutr 1994;19:363.
  • 11. Abenavoli L, Milic N, De Lorenzo A, Luzza F. A pathogenetic link between non-alcoholic fatty liver disease and celiac disease. Endocrine 2013;43(1):65-7.
  • 12. Grant AJ, Lalor PF, Salmi M, Jalkanen S, Adams DH. Homing of mucosal lymphocytes to the liver in the pathogenesis of hepatic complications of inflammatory bowel disease. Lancet 2002;359(9301):150-7.
  • 13. Kruse N, Neumann K, Schrage A, Derkow K, Schott E, Erben U, et al. Priming of CD4+ T cells by liver sinusoidal endothelial cells includes CD25 low fork head box protein 3-regulatory T cells suppressing autoimmune hepatitis. Hepatology 2009;50(6):1904-13.
  • 14. Rubio-Tapia A, Murray JA. The liver in celiac disease. Hepatology 2007;46(5):1650-8.
  • 15. Vajro P, Paolella G, Maggiore G, Giordano G. Pediatric celiac disease, cryptogenic hypertransaminasemia, and autoimmune hepatitis. J Pediatr Gastroenterol Nutr 2013;56(6):663-70.
  • 16. Villalta D, Girolami D, Bidoli E, Bizzaro N, Tampoia M, Liguori M, et al. High prevalence of celiac disease in autoimmune hepatitis detected by anti-tissue transglutaminase autoantibodies. J Clin Lab Anal 2005;19(1):6-10.
  • 17. Novacek G, Miehsler W, Wrba F, Ferenci P, Penner E, Vogelsang H. Prevalence and clinical importance of hypertransaminasaemia in coeliac disease. Eur J Gastroenterol Hepatol 1999;11(3):283-8.
  • 18. van Gerven NM, Bakker SF, de Boer YS, Witte BI, Bontkes H, van Nieuwkerk CM, et al. Seroprevalence of celiac disease in patients with autoimmune hepatitis. Eur J Gastroenterol Hepatol 2014;26(10):1104-7.
  • 19. Nastasio S, Sciveres M, Riva S, Filippeschi IP, Vajro P, Maggiore G. Celiac disease-associated autoimmune hepatitis in childhood: long-term response to treatment. J Pediatr Gastroenterol Nutr 2013;56(6):671-4.
  • 20. Logan RF, Ferguson A, Finlayson ND, Weir DG. Primary biliary cirrhosis and coeliac disease: an association? Lancet 1978;1(8058):230-3.
  • 21. Kingham JG, Parker DR. The association between primary biliary cirrhosis and coeliac disease: a study of relative prevalences. Gut 1998;42(1):120-2.
  • 22. Sorensen HT, Thulstrup AM, Blomqvist P, Nørgaard B, Fonager K, Ekbom A. Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data. Gut 1999;44(5):736-8.
  • 23. Gillett HR, Cauch-Dudek K, Jenny E, Heathcote EJ, Freeman HJ. Prevalence of IgA antibodies to endomysium and tissue transglutaminase in primary biliary cirrhosis. Can J Gastroenterol 2000;14(8):672-5.
  • 24. Dickey W, McMillan SA, Callender ME. High prevalence of celiac sprue among patients with primary biliary cirrhosis. J Clin Gastroenterol 1997;25(1):328-9.
  • 25. Ludvigsson JF, Elfström P, Broomé U, Ekbom A, Montgomery SM. Celiac disease and risk of liver disease: a general population based study. Clin Gastroenterol Hepatol 2007;5(1):63-9.
  • 26. Volta U, Rodrigo L, Granito A, Petrolini N, Muratori P, Muratori L, et al. Celiac disease in autoimmune cholestatic liver disorders. Am J Gastroenterol 2002;97(10):2609-13.
  • 27. Masarone M, Federico A, Abenavoli L, Loguercio C, Persico M. Non alcoholic fatty liver: epidemiology and natural history. Rev Recent Clin Trials 2014;9(3):126-33.
  • 28. Reilly NR, Lebwohl B, Hultcrantz R, Green PH, Ludvigsson JF. Increased risk of non-alcoholic fatty liver disease after diagnosis of celiac disease. J Hepatol 2015;62(6):1405-11.
  • 29. Bakhshipour A, Kaykhaei MA, Moulaei N, Mashhadi MA. Prevalence of coeliac disease in patients with non-alcoholic fatty liver disease. Arab J Gastroenterol 2013;14(3):113-5.
  • 30. Day CP, James OF. Steatohepatitis: a tale of two “hits”? Gastroenterology 1998;114(4):842-5.
  • 31. Nolan JP. The role of intestinal endotoxin in liver injury: a long and evolving history. Hepatology 2010;52(5):1829-35.
  • 32. Noh KW, Poland GA, Murray JA. Hepatitis B vaccine non response and celiac disease. Am J Gastroenterol 2003;98(10):2289-92.
  • 33. Narciso-Schiavon JL, Schiavon Lde L. Autoantibodies in chronic hepatitis C: a clinical perspective. World J Hepatol 2015;7(8):1074-85.
  • 34. Casswall TH, Papadogiannakis N, Ghazi S, Németh A. Severe liver damage associated with celiac disease: findings in six toddler-aged girls. Eur J Gastroenterol Hepatol 2009;21(4):452-9.
  • 35. Kaukinen K, Halme L, Collin P, Färkkilä M, Mäki M, Vehmanen P, et al. Celiac disease in patients with severe liver disease: GFD may reverse hepatic failure. Gastroenterology 2002;122(4):881-8.
  • 36. Kara B, Sandikci M. Successful treatment of portal hypertension and hypoparathyroidism with a gluten-free diet. J Clin Gastroenterol 2007;41(7):724-5.
  • 37. Butterworth JR, Cooper BT, Rosenberg WM, Purkiss M, Jobson S, Hathaway M, et al. The role of hemochromatosis susceptibility gene mutations in protecting against iron deficiency in celiac disease. Gastroenterology 2002;123(2):444-9.
  • 38. Barisani D, Ceroni S, Del Bianco S, Meneveri R, Bardella MT. Hemochromatosis gene mutations and iron metabolism in celiac disease. Haematologica 2004;89(11):1299-305.
  • 39. Gelsi E, Ruitord F, Saint-Paul MC, Filippi J, Arab K, Hébuterne X. Association of Budd-Chiari syndrome with a coeliac disease in patient native from North Africa. Gastroenterol Clin Biol 2004;28(10 Pt 1):903-5.
  • 40. Catassi C, Bearzi I, Holmes GK. Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology 2005;128(4 Suppl 1):S79-86.
  • 41. Sjöberg K, Lindgren S, Eriksson S. Frequent occurrence of non-specific gliadin antibodies in chronic liver disease. Endomysial but no gliadin antibodies predict celiac disease in patients with chronic liver disease. Scand J Gastroenterol 1997;32(11):1162-7.
  • 42. Villalta D, Crovatto M, Stella S, Tonutti E, Tozzoli R, Bizzaro N. False positive reactions for IgA and IgG anti-tissue transglutaminase antibodies in liver cirrhosis are common and method-dependent. Clin Chim Acta 2005;356(1-2):102-9.
  • 43. Clemente MG, Musu MP, Troncone R, Volta U, Congia M, Ciacci C, et al. Enterocyte actin autoantibody detection: a new diagnostic tool in celiac disease diagnosis: results of a multicenter study. Am J Gastroenterol 2004;99(8):1551-6.
İstanbul Tıp Fakültesi Dergisi-Cover
  • Başlangıç: 1916
  • Yayıncı: İstanbul Üniversitesi Yayınevi
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Çölyak hastalığının karaciğer tutulumları

Tolga DÜZENLİ, Alpaslan TANOĞLU