Can high ALT levels be due to celiac disease in a 5-year-old?

Question

Hello doctor,

I have a five-year-old girl diagnosed with celiac disease. Her celiac TTG IgA (tissue transglutaminase antibody) is still high and not in the normal range at 105 U/mL. Her ALT (alanine transaminase) is 35 U/L or around that number on all bloodwork. We have been doing it for nearly one and a half years. AST (aspartate transaminase) is never elevated. We have been referred to the liver doctor and pediatrician.

Can you tell me if this is likely to be autoimmune hepatitis?
Is it concerning that ALT is consistently mildly elevated?

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

I am very sorry about your medical condition, and I am glad you are paying attention to changes in your body system. But do not worry. I am here to take care of you. Thank you for sharing those details. I will break it down carefully for you.

Regarding celiac disease and liver enzymes, it is quite common for children (and adults) with celiac disease to have mild, persistent ALT (alanine transaminase) elevation (“celiac hepatitis”). This often improves once the small intestine heals on a strict gluten-free diet.

Suppose TTG IgA (tissue transglutaminase antibody) remains high (like 105 in your daughter’s case) for over twelve months. That suggests ongoing gluten exposure (hidden gluten, cross-contamination, or sometimes slow healing), keeping the ALT mildly up.

If she is gluten-free or avoids a diet that contains gluten, I believe she will recover, and all the parameters will return to normal. So, persistently mildly elevated ALT with high celiac antibodies is most often related to ongoing gluten exposure or incomplete celiac control and not due to classic autoimmune hepatitis.

It is good and appropriate that you are seeing a pediatric hepatologist. They will check for AIH (autoimmune hepatitis) markers, IgG (immunoglobulin G), ultrasound, and other investigations to rule out.

I hope this answers your query.

Let me know if I need to assist you further.

Thank you.