Liver abnormalities in celiac disease and response to gluten free diet: A systematic review and meta-analysis
Anuraag Jena
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorPraveen Kumar-M
Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorAntriksh Kumar
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorChhagan Lal Birda
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorArup Choudhury
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorNaveen Kumar
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorDaryl Ramai
Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
Search for more papers by this authorAntonio Facciorusso
Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
Search for more papers by this authorCorresponding Author
Jayanta Samanta
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence
Jayanta Samanta, Associate Professor, Department of Gastroenterology, Post Graduate Institute of Medical and Research, Chandigarh, Sector 12, Chandigarh 160012, India.
Email: [email protected]
Search for more papers by this authorAnuraag Jena
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorPraveen Kumar-M
Department of Clinical Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorAntriksh Kumar
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorChhagan Lal Birda
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorArup Choudhury
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorNaveen Kumar
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Search for more papers by this authorDaryl Ramai
Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
Search for more papers by this authorAntonio Facciorusso
Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Foggia, Foggia, Italy
Search for more papers by this authorCorresponding Author
Jayanta Samanta
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Correspondence
Jayanta Samanta, Associate Professor, Department of Gastroenterology, Post Graduate Institute of Medical and Research, Chandigarh, Sector 12, Chandigarh 160012, India.
Email: [email protected]
Search for more papers by this authorAbstract
Background and Aim
Liver involvement in celiac disease (CeD) is known but its various etiologies and the effect of gluten free diet (GFD) on it is understudied.
Methods
We searched PubMed, Medline and Embase databases from date of inception to March 7, 2022, to look for studies reporting on CeD and liver abnormalities. Pooled proportion of CeD patients with deranged transaminases, etiologies of various other liver diseases with CeD and the response to GFD were estimated. Subgroup analyses based on the age group, geographic distribution and duration of GFD were also carried out.
Results
Total 42 studies (8976 patients) reported hyper-transaminasemia in patients with celiac disease. The pooled proportion of patients with elevated transaminases was 21.42% (95% CI: 17.02–26.59, I2 = 94%) overall, with similar prevalence among adults (21.20%) and children (21.51%). The commonest etiology was celiac hepatitis at 49.23% (95% CI: 30.09–68.59, I2 = 87%). Compliance with GFD was noted in 90.27%. The proportion of CeD patients with liver abnormalities who showed response to GFD was 86.39% (95% CI: 80.04–90.95, I2 = 74%) overall.
Conclusion
Liver involvement was noted in 21.42% of CeD patients. Celiac hepatitis was reported in nearly half of them. Good compliance and response were noted with GFD.
Supporting Information
| Filename | Description |
|---|---|
| jgh16039-sup-0001-Supplementary figure 1.pdfPDF document, 66.1 KB |
Figure S1: Forrest plot demonstrating a subgroup analysis of the pooled proportion of celiac disease patients having elevated transaminase levels based on hemisphere of the reported studies, year of the reported studies and duration of follow up reported. Random intercept logistic regression model employing the random effect approach was adopted for computing summary. I2 was used for computing heterogeneity. P value stands for p value of heterogeneity. Abbreviation: CI confidence interval; df: degree of freedom. |
| jgh16039-sup-0002-Supplementary figure 2.pdfPDF document, 60.8 KB |
Figure S2: Forrest plot demonstrating a subgroup analysis of the pooled proportion of celiac disease patients having compliance to gluten free diet based on hemisphere of the reported studies, year of the reported studies and duration of follow up reported. Random intercept logistic regression model employing the random effect approach was adopted for computing summary. I2 was used for computing heterogeneity. P value stands for p value of heterogeneity. Abbreviation: GFD Gluten free diet; CI confidence interval; df: degree of freedom. |
| jgh16039-sup-0003-Supplementary Figure 3.pdfPDF document, 1.2 MB |
Figure S3: Forrest plot demonstrating a subgroup analysis of the pooled proportion of celiac disease patients showing response to gluten free diet based on hemisphere of the reported studies and year of the reported studies. Random intercept logistic regression model employing the random effect approach was adopted for computing summary. I2 was used for computing heterogeneity. P value stands for p value of heterogeneity. Abbreviation: GFD Gluten free diet; CI confidence interval; df: degree of freedom. |
| jgh16039-sup-0004-Supplementary Figure 4.pdfPDF document, 1.2 MB |
Figure S4: Forrest plot demonstrating a subgroup analysis of the pooled proportion of celiac disease patients showing response to gluten free diet based on duration of follow up reported. Random intercept logistic regression model employing the random effect approach was adopted for computing summary. I2 was used for computing heterogeneity. P value stands for p value of heterogeneity. Abbreviation: GFD Gluten free diet; CI confidence interval; df: degree of freedom. |
| jgh16039-sup-0005-Supplementary Figure 5.pdfPDF document, 39.5 KB |
Figure S5: Forrest plot demonstrating a subgroup analysis of the pooled proportion of celiac disease patients showing response to gluten free diet excluding Drastich P et al study for addressing heterogeneity. Random intercept logistic regression model employing the random effect approach was adopted for computing summary. I2 was used for computing heterogeneity. P value stands for p value of heterogeneity. Abbreviation: GFD Gluten free diet; CI confidence interval; df: degree of freedom. |
| jgh16039-sup-0006-Supplementary Figure 6.pdfPDF document, 37.4 KB |
Figure S6: Heterogeneity assessment for proportion of gluten free diet response by Baujat plot and leave-one-out influence analysis. |
| jgh16039-sup-0007-Supplementary Figure 7.pdfPDF document, 59.7 KB |
Figure S7: Heterogeneity assessment for proportion of elevated transaminase levels by Baujat plot and leave-one-out influence analysis. |
| jgh16039-sup-0008-Supplementary Figure 8.pdfPDF document, 43.6 KB |
Figure S8: Forrest plot demonstrating a subgroup analysis of the pooled proportion of celiac disease patients showing response to gluten free diet excluding studies who reported coexisting etiologies for hepatic involvement for addressing heterogeneity. Random intercept logistic regression model employing the random effect approach was adopted for computing summary. I2 was used for computing heterogeneity. P value stands for p value of heterogeneity. Abbreviation: GFD Gluten free diet; CI confidence interval; df: degree of freedom. |
| jgh16039-sup-0009-Supplementary figure 9.pdfPDF document, 27.7 KB |
Figure S9: Heterogeneity assessment for proportion of celiac hepatitis as etiology by Baujat plot and leave-one-out influence analysis. |
| jgh16039-sup-0010-Supplementary Figure 10.pdfPDF document, 12 KB |
Figure S10: Egger's funnel plot showing publication bias of the included studies based on response to gluten free diet. |
| jgh16039-sup-0011-Supplmentary Tables.docxWord 2007 document , 41.1 KB |
Table S1: Search strategy. Table S2: Excluded studies. Table S3: Risk of Bias analysis using Joanna Briggs for the included studies. |
| jgh16039-sup-0012-PRISMA 2009 Checklist.docxWord 2007 document , 22.4 KB |
Data S1. Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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