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• W4252018082 abstract "We thank the authors for their interest in our recent manuscript outlining the evaluation of serum liver chemistry tests. They raise the important issue that elevated serum aminotransferase levels may be due to celiac disease. As noted by the authors, celiac disease is a relatively common entity with a reported prevalence in the United States population of 1:111, although a much smaller percentage of patients present with elevated transaminases of unknown origin.1Fasano A. Catassi C. Current approaches to diagnosis and treatment of celiac disease an evolving spectrum.Gastroenterology. 2001; 120: 636-651Abstract Full Text Full Text PDF PubMed Scopus (1080) Google Scholar, 2Bardella M.T. Vecchi M. Conte D. Del Ninno E. Fraquelli M. Pacchetti S. Minola E. Landoni M. Cesana B.M. De Franchis R. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease.Hepatology. 1999; 29: 654-657Crossref PubMed Scopus (172) Google Scholar, 3Volta U. De Franceschi L. Lari F. Molinaro N. Zoli M. Bianchi F.B. Coeliac disease hidden by cryptogenic hypertransaminasaemia.Lancet. 1998; 352: 26-29Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar Celiac disease can cause asymptomatic chronic hepatitis, and may also present with other subtle manifestations including unexplained anemia, skin, bone, or neurologic disease. The authors raise the concern of whether serologic evaluation for celiac disease should routinely be performed as part of the initial evaluation of abnormal serum liver chemistry tests. As we emphasized in the AGA Technical Review, the initial evaluation of patients with abnormal serum liver chemistries tests should be based on the history and physical examination findings, rather than a strict adherence to an algorithm. The clinical presentation of occult hepatic disease with elevated aminotransferases caused by celiac disease is significantly lower than the reported 1:111 overall prevalence of celiac disease, potentially by an order of magnitude.1Fasano A. Catassi C. Current approaches to diagnosis and treatment of celiac disease an evolving spectrum.Gastroenterology. 2001; 120: 636-651Abstract Full Text Full Text PDF PubMed Scopus (1080) Google Scholar, 2Bardella M.T. Vecchi M. Conte D. Del Ninno E. Fraquelli M. Pacchetti S. Minola E. Landoni M. Cesana B.M. De Franchis R. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease.Hepatology. 1999; 29: 654-657Crossref PubMed Scopus (172) Google Scholar, 3Volta U. De Franceschi L. Lari F. Molinaro N. Zoli M. Bianchi F.B. Coeliac disease hidden by cryptogenic hypertransaminasaemia.Lancet. 1998; 352: 26-29Abstract Full Text Full Text PDF PubMed Scopus (206) Google Scholar Nonetheless, the authors appropriately emphasized that dietary modifications is an effective therapy for celiac disease, and thus it is important to avoid misdiagnosis of this pathologic entity. We believe that a decision on whether to initially obtain serologic studies for celiac disease should be based on the history and physical examination, rather than routinely performed as part of the initial evaluation of abnormal aminotransferases. The prevalence of celiac disease will depend on the age, race, demographic characteristics, and concomitant diseases of the patient. Significant signs or symptoms of malabsorption, or severe weight abnormality may also be important in this decision, albeit with the recognition that celiac disease can have an occult presentation. Based on these historical and physical examination findings, we feel that the decision can best be made on whether for a specific patient, the evaluation of celiac disease should occur as a primary evaluation for abnormal serum liver chemistry tests, or as a secondary evaluation if other common causes of hepatic disease are not evident. Nonetheless, we agree that celiac disease represents a potentially treatable, and frequently unrecognized cause of liver disease, which must be considered in all evaluations of abnormal liver serum chemistry tests." @default.
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• W4252018082 date "2003-07-01" @default.
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• W4252018082 doi "https://doi.org/10.1016/s0016-5085(03)00825-4" @default.
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