A nationwide cohort study has revealed that patients with celiac disease may have a twofold increased risk of chronic liver disease, with this elevated risk persisting for more than 25 years. 

In the study, published in The Lancet Regional Health–Europe, investigators analyzed data from 48,027 Swedish patients with biopsy-confirmed celiac disease (CeD) and 231,909 matched reference individuals from the general population. Over a median follow-up of 16 years, 649 patients with CeD developed chronic liver disease (CLD) compared with 1,571 controls, corresponding to an incidence rate of 79.4 vs 39.5 per 100,000 person-years.

Patients with CeD had an adjusted hazard ratio (HR) of 2.01 (95% confidence interval [CI] = 1.82–2.22) for developing any CLD. The excess risk translated to one additional case of chronic liver disease per 110 patients with CeD over 25 years.

The study further identified significantly increased risks for specific CLD etiologies, including:

• Autoimmune liver disease (adjusted HR = 4.86, 95% CI = 3.87–6.11)
• Metabolic dysfunction–associated steatotic liver disease (adjusted HR = 2.54, 95% CI = 2.05–3.14)
• Alcohol-related liver disease (adjusted HR = 1.51, 95% CI = 1.27–1.79).

In addition to these findings, the patients with CeD were 54% more likely to develop major adverse liver outcomes (MALO), including compensated or decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, or liver-related death (adjusted HR = 1.54, 95% CI = 1.36–1.75).

The elevated risk of CLD in patients with CeD remained significant even 25 years after diagnosis. The study authors emphasized the importance of monitoring for early signs of liver dysfunction in patients with CeD. 

The findings highlighted the need for vigilance regarding liver health in patients with CeD.

"CeD is associated with a persistently increased risk of any incident CLD, although the absolute risk is low. Physicians should be vigilant to early signs of liver dysfunction in patients with CeD," emphasized lead study author Jialu Yao, of the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, Sweden, and colleagues.

Sibling-controlled analyses and sensitivity testing confirmed the robustness of the findings, ruling out confounding by genetic or environmental factors.

The study was funded by the European Crohn's and Colitis Organisation, the Swedish Society for Medical Research, and the Swiss National Science Foundation.

No conflicts of interest were disclosed by the authors.