Immunologically mediated liver diseases belong to the common extraintestinal manifestations of celiac disease. In celiac disease, increased intestinal permeability is thought to be an early feature in the pathogenesis.
Dietary gluten drives intestinal inflammation and impairs the function of the small intestinal barrier. It has been demonstrated that patients having active (untreated) celiac disease with elevated serum transaminases ("liver tests") have a more severely compromised intestinal barrier and greater intestinal permeability than those having active celiac disease with normal liver tests; and both intestinal permeability and transaminases normalize when patients follow a gluten-free diet.