Celiac disease may present as a cryptogenic liver disorder being found in 5–10% of patients with a persistent and cryptogenetic
elevation of serum aminotransferase activity. In fact, a wide spectrum of liver injuries in children and adults may be related
to CD and in particular: (1) a mild parenchymal damage characterised by absence of any clinical sign or symptom suggesting
a chronic liver disease and by non-specific histological changes reversible on a gluten-free diet; (2) a chronic inflammatory
liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis,
that may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive
treatment; (3) a severe liver failure potentially treatable by a gluten-free diet. Such different types of liver injuries
may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, precocity and duration
of exposure to gluten may influence the reversibility of liver damage. A rigorous cross-checking for a asymptomatic liver
damage in CD individuals and conversely, for CD in any cryptogenic liver disorder including end-stage liver failure is recommended.
Key words Celiac disease - Autoimmune liver disease - Acute liver failure - Cryptogenic liver damage