The Long-term Risk of Chronic Liver Disease in Celiac Disease Patients

Celiac.com 01/16/2025 - Celiac disease, an autoimmune condition triggered by gluten consumption, is known for its gastrointestinal and systemic impacts. Recent research indicates potential connections between celiac disease and chronic liver disease. This summary highlights findings from a large-scale Swedish study that explored whether celiac disease increases the long-term risk of chronic liver disease and major liver-related complications.

Study Methods and Design

The study utilized data from the Swedish ESPRESSO cohort, incorporating over 48,000 individuals diagnosed with celiac disease through intestinal biopsy between 1969 and 2017. These participants were compared to nearly 232,000 matched individuals from the general population. Researchers followed these groups until 2021 to evaluate the incidence of chronic liver disease, including conditions such as autoimmune liver disease, metabolic dysfunction-associated liver disease, alcohol-related liver disease, and viral hepatitis. Major adverse liver outcomes, such as cirrhosis, liver cancer, liver transplantation, and liver-related death, were also assessed.

Elevated Risk of Chronic Liver Disease

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Celiac disease patients exhibited a twofold higher risk of developing chronic liver disease compared to the general population. This increased risk persisted for over 25 years after diagnosis. For every 110 individuals with celiac disease, one additional case of chronic liver disease was observed within this timeframe.

Specific Liver Conditions

The study found varying levels of increased risk depending on the type of liver disease:

Autoimmune Liver Disease: Patients with celiac disease were nearly five times more likely to develop autoimmune liver conditions.

Metabolic Dysfunction-Associated Liver Disease: This condition was 2.5 times more common in individuals with celiac disease.

Alcohol-Related Liver Disease: A moderate increase in risk (1.5 times) was noted for alcohol-related liver disease.

Major Liver Complications

Celiac disease patients faced a 54% higher risk of major adverse liver outcomes, including liver failure, liver-related death, and liver cancer.

Factors Influencing Liver Disease Risk

Diagnostic Bias

The elevated risk was most pronounced shortly after celiac diagnosis, potentially due to diagnostic workups that identified existing liver abnormalities. However, even after accounting for this, the risk remained elevated for decades.

Genetics and Autoimmune Links

The study highlighted shared genetic predispositions between celiac disease and autoimmune liver conditions, particularly involving HLA genes.

Diet and Metabolism

Adopting a gluten-free diet, essential for managing celiac disease, can sometimes lead to rapid weight gain or an imbalanced diet, which may increase the risk of metabolic-related liver diseases.

Implications for Patients and Physicians

Monitoring and Prevention

While the absolute risk of chronic liver disease remains low, the findings underscore the importance of regular liver enzyme monitoring for individuals with celiac disease, especially during the early years after diagnosis. Physicians should be vigilant for signs of liver dysfunction, particularly in those with additional risk factors, such as metabolic disorders or autoimmune conditions.

Patient Education

Educating patients about maintaining a balanced gluten-free diet and avoiding excessive alcohol consumption could reduce liver-related risks. Patients with elevated liver enzymes may benefit from closer dietary and metabolic monitoring.

Conclusion

This study highlights a persistent, albeit low, increased risk of chronic liver disease in individuals with celiac disease. The findings emphasize the need for proactive monitoring and preventive measures to mitigate long-term liver-related complications. For patients with celiac disease, understanding these risks and collaborating with healthcare providers can lead to better overall management and long-term health outcomes.

Read more at: thelancet.com