Meta-Analysis: Pediatric Celiac Disease, Cryptogenic Hypertransaminasemia, and Autoimmune Hepatitis.
J Pediatr Gastroenterol Nutr. 2013 Feb 22. Epub 2013 Feb 22. PMID: 23434875
*Chair of Pediatrics, School of Medicine at the University of Salerno, Salerno and European Laboratory for the Investigation of Food-Induced Diseases, ELFID, Naples, Italy†Department of Pediatrics, University Hospital Santa Chiara, Pisa, Italy ‡Department of Economics and Statistics Science, University of Salerno, Italy.
OBJECTIVE:: The association between celiac disease (CeD) and liver disease in pediatrics is well recognized, but its prevalence is unknown. This study aims to conduct a systematic review and meta-analysis to evaluate the prevalence of CeD in children with cryptogenic persistent hypertransaminasemia (HTS) or autoimmune hepatitis (AIH), and vice-versa. METHODS:: We searched MEDLINE/PubMed, the Cochrane Library, Web of Science, and MD consult from 1977 to May 2012 for studies reporting either CeD and HTS or AIH. Pooled prevalences with 95% confidence intervals (CI) and relative risk (RR) were calculated. RESULTS:: Nine studies (2046 patients) were identified. Pooled prevalences of CeD in children with mild, non-specific cryptogenic persistent HTS and vice-versa were 12.0% (95% CI 4.17-29.96) and 36.0% (95% CI 32.15-40.11), respectively. A gluten-free diet normalized transaminase levels in 77%-100% of CeD patients within 4-8 months. Pooled prevalences of CeD in children with AIH and vice-versa were 6.3% (95% CI 3.87-11.73) and 1.4% (95% CI 0.84-2.15), respectively. The RR of HTS in children with CeD versus the general population, and of CeD in children with HTS was 6.55 (95% CI 5.65-7.60) and 11.59 (95% CI 3.80-35.33), respectively. The corresponding RRs of AIH in children with CeD were 188.54 (95% CI 92.23-385.43). The RR of CeD in children with AIH was 6.63 (95% CI 3.86-11.40). CONCLUSIONS:: CeD is associated with elevated transaminase levels in about one-third of newly diagnosed children. Cryptogenic persistent HTS may signal gluten-dependent non-specific mild hepatitis (12.0% of cases) or more rarely (6.3%) severe CeD-related autoimmune hepatopathy. RRs confirm these trends in the considered associations.