Celiac disease is a chronic autoimmune disorder where consuming gluten, a protein found in wheat, barley, and rye, triggers an immune reaction that damages the lining of the small intestine. While the primary effect is intestinal damage, this condition is recognized as a multi-system disorder that can affect other organs, including the liver. Untreated celiac disease can cause liver damage, as abnormalities in liver function are common in patients with undiagnosed celiac disease. This association highlights the close biological relationship between the digestive system and the liver, often referred to as the gut-liver axis, which is disrupted by intestinal inflammation.
Liver Abnormalities Associated with Untreated Celiac Disease
The most frequent sign of liver involvement is elevated liver enzymes, known as hypertransaminasemia or “celiac hepatitis.” Up to 60% of patients with newly diagnosed celiac disease may present with increased levels of enzymes like alanine aminotransferase (ALT) and aspartate aminotransferase (AST). This elevation is usually asymptomatic and discovered incidentally during routine blood work.
Celiac disease increases the risk for fat buildup in the liver, referred to as metabolic dysfunction-associated steatotic liver disease (MASLD). People with celiac disease have nearly three times the risk of developing MASLD compared to the general population. This fatty liver can occur even in people who are not overweight or obese, which is unusual for this condition.
In some cases, celiac disease is the underlying cause of liver problems when other typical factors, such as alcohol or viral infections, have been ruled out. This is referred to as cryptogenic liver disease, where the source of the liver damage is unknown. Physicians may recommend screening for celiac disease in patients with unexplained chronic hepatitis or cirrhosis.
How Untreated Celiac Disease Triggers Liver Damage
The physiological link between intestinal inflammation and liver injury is the disruption of the gut-liver axis. Intestinal damage from gluten exposure compromises the small intestine’s barrier function, leading to “leaky gut.” This increased intestinal permeability allows substances that should remain confined to the gut to pass into the bloodstream.
These substances (food antigens, bacterial components, and toxins) are carried directly to the liver through the portal vein, which drains blood from the intestines. The liver processes this increased load, triggering a localized immune response and chronic inflammation (hepatitis). These inflammatory signals can lead to cellular stress and eventual damage.
Malabsorption and nutritional deficiencies also contribute to liver changes. Although the increased toxin load is a primary driver, poor absorption of vitamins and nutrients can worsen liver health and play a role in developing fatty liver changes. This combination of systemic inflammation and metabolic disruption creates an environment prone to liver injury.
Reversing Liver Complications with a Gluten-Free Diet
The primary treatment for celiac disease and its associated liver complications is strict adherence to a lifelong gluten-free diet (GFD). The most common liver abnormalities, particularly the mild elevations in liver enzymes, are reversible with this dietary change. This resolution, often referred to as celiac hepatitis, usually occurs within 6 to 12 months of starting the GFD.
For patients with celiac-associated fatty liver disease, the GFD can lead to an improvement in liver tests and a reduction in fat accumulation. In rare, severe cases of liver failure linked to undiagnosed celiac disease, strict gluten withdrawal has been shown to reverse hepatic dysfunction. This reversibility confirms the direct link between active celiac disease and the liver injury.
Physicians monitor liver function tests after starting the GFD to confirm enzyme levels return to the normal range. If liver abnormalities persist beyond the expected 6 to 12-month period, it may suggest a coexisting, more serious liver condition. Celiac disease is associated with a higher risk for other autoimmune liver diseases (such as autoimmune hepatitis or primary biliary cholangitis), which require additional treatment.