Prevalence and clinical importance of hypertransaminasaemia in coeliac disease

Objective To assess the prevalence and potential pathogenetic factors of hy pertransaminasaemia in patients with coeliac disease prior to initiation of a gluten-free diet (GFD) and to assess the course of transaminases on a GF D. Patients A retrospective study was made of 178 patients with coeliac diseas e (130 women, 48 men; median age 36 years; range 17-84 years) at the gastro enterological department of a university hospital. Methods Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured prior to initiation of a GFD and at 3, 6 and 12 months of GF D. Intestinal permeability, a test for functional integrity of the small bo wel, was investigated before starting a GFD in 116 patients by an oral test using lactulose and mannitol. Results In 72 patients (40.4%) AST and/or ALT were increased prior to initi ation of a GFD. Within 1 year on a GFD ALT and AST normalized except in eig ht cases (4.6%). The intestinal permeability index (% lactulose/% mannitol in 5 h urine) was higher in patients with elevated (median 0.34; range 0.03 -1.43) than in patients with normal transaminases (0.11; 0.02-1.28) (P < 0. 0001) and correlated with AST (tau = 0.34; P < 0.0001) and ALT (tau = 0.32; P < 0.0001). In five cases with hypertransaminasaemia a liver biopsy was p erformed prior to initiation of a GFD. Two patients had mild to moderate he patitis with septal fibrosis. The other three had minimal lymphocytic infil trates of the portal tracts. inflammatory alterations of the bile ducts wer e not found. Conclusion Hypertransaminasaemia before GFD is frequent in coeliac patients , correlates with intestinal permeability and normalizes on a GFD in most p atients. In cases of persistently elevated liver function tests of unknown origin underlying coeliac disease should be considered. Eur J Gastroenterol Hepatol 11:283-288 (C) 1999 Lippincott Williams & Wilkins.