Changing Epidemiology of Liver Involvement in Children with Celiac Disease
| Autor: | Vincenzo Villanacci, Tarcisio Not, Samuele Naviglio, Elisa Benelli, Alessandro Ventura, Manuela Giangreco, Giacomo Stera, Stefano Martelossi, Luca Ronfani, Luigina De Leo |
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| Přispěvatelé: | Benelli, Elisa, Naviglio, Samuele, De Leo, Luigina, Stera, Giacomo, Giangreco, Manuela, Ronfani, Luca, Villanacci, Vincenzo, Martelossi, Stefano, Ventura, Alessandro, Not, Tarcisio |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Epidemiology Aspartate transaminase Gastroenterology Hypertransaminasemia Pediatrics 03 medical and health sciences 0302 clinical medicine Interquartile range 030225 pediatrics Internal medicine Prevalence medicine Celiac hepatiti Humans Risk factor Child Univariate analysis biology business.industry Liver Diseases Infant Newborn Infant Alanine Transaminase Odds ratio Celiac hepatitis medicine.disease Celiac Disease Italy Alanine transaminase Child Preschool Pediatrics Perinatology and Child Health biology.protein Gluten-free diet Elevated transaminases Female 030211 gastroenterology & hepatology business |
| Popis: | Objectives Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15%-57%, autoimmune liver disease 1%-2%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD. Methods Children (age 0-18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet. Results CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9%), and were elevated in 27 (3.9%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49-80 U/L) and 67 U/L (interquartile range 53-85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age ≤4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95% confidence interval: 1.61-8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis. Conclusions Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare. |
| Databáze: | OpenAIRE |
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