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Research estimates that 18%-40% of people with gluten-related diseases show elevated liver enzymes, and about 9% of unexplained hypertransaminasemia cases are linked to gluten sensitivity. Gluten can range from mild transaminase rises to autoimmune liver disorders, steatotic disease, and cirrhosis. A gluten-free diet normalizes liver enzymes in 75%-90% within 1 year, though long-term adherence may relate to higher BMI, insulin resistance, and steatosis risk.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/glutens-silent-strike-unmasking-its-impact-on-liver-health/406615/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/glutens-silent-strike-unmasking-its-impact-on-liver-health/406615.png","ImageObject",300,407,{"name":92,"@type":93},"Mimi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How is gluten linked to liver health in this review?","Question",{"text":113,"@type":114},"The review describes gluten’s role in the gluten-liver axis and connects it to metabolic dysfunction-associated steatotic liver disease and other hepatic manifestations of gluten sensitivity.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What range of liver conditions can gluten sensitivity cause?",{"text":118,"@type":114},"Hepatic manifestations range from mild transaminase elevations to autoimmune liver diseases, steatotic liver disease, and even cirrhosis.",{"name":120,"@type":111,"acceptedAnswer":121},"What is the reported effect of a gluten-free diet on liver enzymes?",{"text":122,"@type":114},"A gluten-free diet normalizes liver enzymes in about 75%-90% of cases within 1 year, but long-term adherence may be associated with higher BMI, insulin resistance, and increased steatosis risk.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},406615,1790673120,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},2336477974920,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","| W | J | G | P | World Journal of\u003Cbr>Gastrointestinal Pathophysiology |\n| --- | --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Pathophysiol 2025 December 22; 16(4): 111957  \nDOI: 10.4291/wjgp.v16.i4.111957 ISSN 2150-5330 (online)  \nMINIREVIEWS  \nGluten’s silent strike: Unmasking its impact on liver health  \nShivam Kalra, Simran Joshi, Manjeet K Goyal, Kartikay Goyal, Bhupender Singh, Ashita R Vuthaluru, Omesh Goyal  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B, Grade C, Grade D  \nNovelty: Grade B, Grade C, Grade C  \nCreativity or Innovation: Grade B, Grade C, Grade C  \nScientific Significance: Grade B, Grade C, Grade C  \nP-Reviewer: He YH, MD, Associate Chief Physician, China; Mohamed DAA, PhD, Professor, Egypt; Zhang L, MD, China  \nReceived: July 17, 2025  \nRevised: August 18, 2025  \nAccepted: November 14, 2025  \nPublished online: December 22, 2025  \nProcessing time: 159 Days and 5.4 Hours  \nShivam Kalra, Internal Medicine, Trident Medical Center, Charleston, SC 29405, United States  \nSimran Joshi, Department of Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT 06610, United States  \nManjeet K Goyal, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India  \nKartikay Goyal, Department of Medicine, Government Medical College and Hospital, Chandigarh 160030, India  \nBhupender Singh, Department of Gastroenterology, Amar Hospital, Patiala 147001, Punjab, India  \nAshita R Vuthaluru, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India  \nOmesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India  \nCo-corresponding authors: Manjeet K Goyal and Omesh Goyal.  \nCorresponding author: Omesh Goyal, Professor, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, Punjab, India.  \n[dromeshgoyal@gmail.com](dromeshgoyal@gmail.com)  \nAbstract  \nOnce considered a concern solely for the gut, gluten is now recognized as an important factor in the pathogenesis of metabolic dysfunction-associated steatotic liver disease. Studies estimate that 18%-40% of individuals with gluten-related diseases have elevated liver enzyme levels, with 9% of patients with unexplained hypertransaminasemia ultimately diagnosed with gluten sensitivity. Hepatic manifestations of gluten sensitivity range from mild transaminase elevations to autoimmune liver diseases, metabolic dysfunction-associated steatotic liver disease, and even cirrhosis. Up to 50% of untreated cases of gluten-induced liver dysfunction show significant hepatic injury, which can lead to liver failure in severe cases. The pathophysiology is multifaceted and involves increased intestinal permeability, immune dysregulation, and shared genetic risk factors. A gluten-free diet leads to normalized liver enzymes in 75%-90% of cases within 1 year. Long-term gluten-free diet adherence has been paradoxically linked to  \n WJGP  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 22, 2025  Volume 16  Issue 4   \nKalra S et al. Gluten and liver  \nhigher body mass index, insulin resistance and increased hepatic steatosis risk, which raise concerns about its metabolic impact. Our review dissects the gluten-liver axis, emphasizing a need for early recognition, targeted screening, and personalized dietary interventions. Ultimately, given the increasing global burden of metabolic and autoimmune liver diseases, understanding gluten’s role is essential for optimizing liver health and preventing progressive hepatic injury.  \nKey Words: Gluten; Liver dysfunction; Gut-liver axis; Gluten-free diet; Metabolic liver disease; A","cbCairWS92cN2Dz9","https://ap.wps.com/l/cbCairWS92cN2Dz9","pdf",1118615,11,"English","# Introduction\n## Gluten-related disorders (GRDs)\n# Core Tip and Overview\n## Gluten’s hepatic implications\n# Abstract and Key Findings\n## Prevalence of liver enzyme elevation and clinical spectrum\n## Mechanisms and treatment response","[{\"question\":\"How is gluten linked to liver health in this review?\",\"answer\":\"The review describes gluten’s role in the gluten-liver axis and connects it to metabolic dysfunction-associated steatotic liver disease and other hepatic manifestations of gluten sensitivity.\"},{\"question\":\"What range of liver conditions can gluten sensitivity cause?\",\"answer\":\"Hepatic manifestations range from mild transaminase elevations to autoimmune liver diseases, steatotic liver disease, and even cirrhosis.\"},{\"question\":\"What is the reported effect of a gluten-free diet on liver enzymes?\",\"answer\":\"A gluten-free diet normalizes liver enzymes in about 75%-90% of cases within 1 year, but long-term adherence may be associated with higher BMI, insulin resistance, and increased steatosis risk.\"}]","Gluten’s silent strike - Unmasking its impact on liver health | PDF",1790566746,28]