Liver Abnormalities Respond to Gluten-Free Diet in Patients With Celiac Disease

A gluten-free diet improved liver abnormalities among adults and children with celiac disease.

Almost around a quarter of patients with celiac disease (CeD) had hepatic abnormalities, with over half of these patients exhibiting celiac hepatitis; however, compliance with a gluten-free diet resulted in positive responses such as improved liver function, according to findings published in the Journal of Gastroenterology and Hepatology.

Researchers conducted a systematic review and meta-analysis, searching PubMed, Medline, and Embase databases from inception until March 7, 2022.  A total of 51 studies were included in the meta-analysis — 42 studies analyzed a total of 8976 patients with CeD, while the other 9 studies reported response of patients with CeD to a gluten-free diet.

Of these 8976 patients with CeD, 21.42% exhibited hypertransaminasemia (95% CI, 17.02-26.59), with similar percentages observed across adult and pediatric patient populations.

The most common pathological reason for elevated liver transaminases in these patients was celiac hepatitis (49.23%; 95% CI, 30.09-68.59). Celiac hepatitis occurs in the absence of other possible underlying hepatic pathologies, while clinically responding to a gluten-free diet. Therefore, liver abnormalities indicative of liver injury caused by celiac hepatitis also often clinically respond to a gluten-free diet.

Most patients with CeD across the studies were strictly adherent to a gluten-free diet (90.27%). Approximately 86.39% of patients with CeD with liver abnormalities showed positive responses with reduction of transaminase levels if they remained compliant to a gluten-free diet (95% CI, 80.04-90.95).

 “Awareness of the presence of liver abnormalities in CeD patients and stressing on strict compliance to GFD [gluten-free diet] are of paramount importance to prevent morbidity including long-term complications of liver diseases in patients with CeD,” the study authors noted.

Study limitations include heterogeneity of information detailing the prevalence of abnormal liver function tests globally, limited data availability regarding biopsy-confirmed celiac hepatitis, lack of accounting for additional confounding variables, potential reporting bias, and lack of studies available to analyze the effects of a gluten-free diet in those with celiac compared with the general population.


Jena A, Kumar-M P, Kumar A, et al. Liver abnormalities in celiac disease and response to gluten free diet: A systematic review and meta-analysis.  J Gastroenterol Hepatol. Published online October 27, 2022. doi:10.1111/jgh.16039