Is coeliac disease a potentially treatable cause of liver failure?

Hypertransaminasaemia occurs in up to 40% of patients with coeliac disease and resolves with a gluten-free diet. Chronic liver disease such as primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and chronic autoimmune hepatitis is associated with coeliac disease. Coeliac disease is up to 10 times more frequent among patients with chronic liver disease than the general population. Increased intestinal permeability, small intestinal bacterial overgrowth, Kupffer cell abnormalities, direct toxicity of gliadin peptides, or a gliadin-stimulated immunopathological process may have a role to play in the progression of chronic liver disease among coeliac patients. The institution of a gluten-free diet leads to an improvement in those patients with liver failure and previously undiagnosed coeliac disease.