Celiac disease and liver problems are more closely connected than many people realize, especially when liver enzymes remain elevated without a clear explanation.
Celiac disease is a systemic autoimmune disease.
It can affect organs throughout the body. Today, we are discussing the liver.
Blood from the small intestine travels directly to the liver, so inflammation and increased intestinal permeability in untreated celiac disease may affect the liver too. Researchers are still working out exactly why.
Also, hepatitis simply means liver inflammation.
First, celiac hepatitis is usually mild, silent, and reversible. It sounds scary, but it often improves on a gluten-free diet.
A large meta-analysis found that more than 20% of newly diagnosed celiac patients had elevated liver enzymes. It also found that about 3% to 4% of people with persistent, unexplained elevated liver enzymes were eventually diagnosed with celiac disease.
Long-term follow-up research found that these liver tests often returned to normal after starting a gluten-free diet.
Second, autoimmune liver diseases—including autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis—are separate conditions. They are not usually managed with a gluten-free diet alone.
This matters because a 2021 meta-analysis found that celiac disease is more common among people with autoimmune hepatitis.
Third, fatty liver disease can occur with treated or untreated celiac disease. It happens when excess fat builds up in the liver. It may remain mild, but in some people it can progress to significant inflammation and liver damage.
A Swedish study found an increased risk of fatty liver disease after celiac diagnosis. The increase was highest during the first year, but the elevated risk continued beyond that.
Ironically, a gluten-free diet may resolve gluten-responsive liver inflammation while doing nothing to prevent metabolic fatty liver disease.
Finally, liver testing is often included in routine blood work. Abnormal results should be evaluated, but they do not automatically mean liver failure—or that gluten exposure is to blame.
However, when liver tests remain abnormal without a clear explanation, celiac disease may be the root cause, even without obvious digestive symptoms.
None of this is meant to scare you. It is meant to give you information to discuss with your doctor.
And if you have not had a follow-up visit in a while, now may be a good time to schedule one.
This is for educational purposes only and is not medical advice.
Want more information?
Celiac disease is a systemic autoimmune disease, which means it can affect far more than the digestive system.
Liver testing is often included in routine blood work, but it is only one part of the ongoing follow-up people with celiac disease should receive.
This is part of my series about how celiac disease can affect the whole body. Yesterday, we discussed celiac disease and kidney health.
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