Chronic unexplained hypertransaminasemia may be caused by occult celiac disease

In a subset of patients attending liver units, a chronic increase in serum transaminases may remain of undetermined cause despite thorough investigati ons. On the other hand, elevated levels of serum transaminases have been re ported in about 40% of adult celiac patients. To evaluate the prevalence of subclinical celiac disease in patients with chronic unexplained hypertrans aminasemia in comparison with that in the general population (0.5%), 140 co nsecutive patients with chronic increases of serum transaminases levels of unknown cause were tested for antigliadin and antiendomysium IgA antibodies . All patients with positive antibody tests were offered upper gastrointest inal endoscopy with distal duodenal biopsy. Thirteen patients (9.3%, 95% co nfidence interval 5.0-15.4) had positive antigliadin and antiendomysium ant ibodies, The prevalence of antibodies was 17% in women and 5.4% in men (8/4 7 vs. 5/93 respectively; relative risk 3.2, 95% confidence interval 1.1-9.1 ). Distal duodenal biopsy performed in all but one of the patients showed m ild villous atrophy with increased intraepithelial lymphocytes in three cas es, subtotal villous atrophy in six, and total villous atrophy in three. Th e prevalence of celiac disease in the patient group was significantly highe r than that in the general population (P < .001) with a relative risk of 18 .6 (95% confidence interval 11.1-31.2). On the basis of the present finding s, screening for celiac disease is an important tool in the initial diagnos tic work-up of patients with chronic unexplained hypertransaminasemia.