Correlation of elevated transaminases and histological findings in children with celiac disease: a retrospective cross-sectional study

Abstract

Background: Celiac disease (CD) is a common chronic immune-mediated enteropathy, with 1% prevalence in North America. Initial screening for CD with serum tissue transglutaminase (tTG) immunoglobulin A (IgA) levels is the current recommendation by most consensus authorities, although, this value does not correlate with the extent of luminal or extra-luminal disease severity. Hypertransaminasemia is commonly reported in CD and despite this well recognized finding, the association and correlation of elevated transaminases with disease severity has not been determined. Our study aimed to determine whether elevated transaminases can be used as a surrogate marker to predict the severity of histologic disease in paediatric patients. Methods: We performed a retrospective cross-sectional chart review of all children ages 6 months to 17 years referred for suspected CD to the Paediatric Gastroenterology and Hepatology Division at Children’s Hospital, London Health Sciences Centre from June 1, 2008 to June 28, 2016. Age at diagnosis, transaminases measured within 6 months, CD histological confirmation, and no other causes of liver injury were included. A total of 347 children were identified, and 44 (mean age: 10.4 years) were included after the exclusion criteria was applied. Bivariate analysis was applied using Kruskal-Wallis and Chi-square tests for continuous and categorical variables, respectively. Logistic regression and Spearman correlations were also applied to the data to determine the strength of our hypothesized association. Results: Our study demonstrated no statistical significance between any of the serum transaminase levels and histologic severity of disease. These corresponded to alanine aminotransferase (ALT) (P=0.503), aspartate aminotransferase (AST) (P=0.291), gamma-glutamyl transferase (GGT) (P=0.379) and alkaline phosphatase (ALP) (P=0.095). However, our results may suggest a trend toward more advanced disease or longer standing protein-losing enteropathy at presentation as shown by a lower IgG value (P=0.021). Our study also supported the correlation between histological disease severity and patients who experienced diarrhea as a presenting symptom (P=0.002). Conclusions: Although elevated transaminases and CD is well recognized, our study did not show an association between histological disease severity and degree of elevated transaminases.