The gluten-free diet prescribed for the digestive disorder celiac disease may reverse liver failure in some patients with both conditions.
And, the relatively high frequency of undiagnosed celiac disease among people with serious liver conditions suggests the disorder should be looked for in certain liver disease patients.
Celiac disease is a digestive disorder that damages the small intestine and interferes with the normal absorption of nutrients from food. It arises from an allergic reaction to gluten, a protein found in wheat, rye, barley, oats and spelt.
The problem often goes undetected because many of its symptoms -- such as abdominal pain, fatigue and diarrhea -- are similar to a range of other disorders. And some patients have no symptoms.
Celiac disease is also associated with other disorders caused by immune system dysfunction, including immune system-related liver diseases like autoimmune hepatitis.
In their study of 185 patients who had received liver transplants, researchers found that eight patients -- or just over 4% -- had celiac disease. Two of these eight had not been diagnosed previously, and in five patients, the liver disorder had developed when their celiac disease was still undiagnosed. Only one had stuck to a long-term gluten-free diet before the liver transplant.
Moreover, in another four patients with advanced liver disease and untreated celiac disease, the investigators found that a gluten-free diet reversed patients' liver dysfunction.
The two who have adhered to the diet remain in good condition, the researchers report. One patient who did not stick with the diet saw his liver disease progress and eventually had a liver transplant.
These findings suggest that in such patients, dietary intervention may prevent progression to liver failure.
And, they point out, their finding that about 4% of liver transplant patients had celiac disease -- usually associated with autoimmune liver disorders -- indicates that celiac disease should be "rigorously investigated" in all patients with autoimmune hepatitis or hepatitis with no known cause.
In some cases, early detection and treatment of celiac disease may prevent progression to end-stage liver failure.
Gastroenterology April 2002;122:881-888
Most of us seem to benefit by avoiding wheat and the major protein that is in wheat, gluten.
Celiac disease has been considered rare in this country, it often goes undiagnosed or is misdiagnosed as irritable bowel syndrome or lactose intolerance. As many as one in 33 have a profound problem with gluten that results in celiac disease.
My experience is that the true incidence is probably much higher still, perhaps on the order of 1 in 10 people.
One of the major problems with celiac disease is that it maybe very difficult to diagnose. Probably the best way to diagnose it is to go on a gluten free diet and see if your symptoms improve.
If you have hepatitis, or any type of liver disease, it would certainly seem reasonable to avoid gluten for a few weeks and see what happens to your liver.
What have you got to lose? In some cases, as this study shows, a liver transplant.
Not only is avoiding gluten useful for many with celiac disease, but interferon, which is used to treat many with hepatitis, can actually cause celiac disease.