Gluten’s silent strike: Unmasking its impact on liver health

doi:10.4291/wjgp.v16.i4.111957

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World Journal of Gastrointestinal Pathophysiology

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2150-5330

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Pathophysiol. Dec 22, 2025; 16(4): 111957
Published online Dec 22, 2025. doi: 10.4291/wjgp.v16.i4.111957

Gluten’s silent strike: Unmasking its impact on liver health

Shivam Kalra, Simran Joshi, Manjeet K Goyal, Kartikay Goyal, Bhupender Singh, Ashita R Vuthaluru, Omesh Goyal

Shivam Kalra, Internal Medicine, Trident Medical Center, Charleston, SC 29405, United States

Simran Joshi, Department of Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT 06610, United States

Manjeet K Goyal, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India

Kartikay Goyal, Department of Medicine, Government Medical College and Hospital, Chandigarh 160030, India

Bhupender Singh, Department of Gastroenterology, Amar Hospital, Patiala 147001, Punjab, India

Ashita R Vuthaluru, Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India

Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India

Co-corresponding authors: Manjeet K Goyal and Omesh Goyal.

Author contributions: Kalra S, Joshi S, Goyal MK, Goyal K, Singh B, Vuthaluru AR, and Goyal O performed the literature search, contributed to writing of the original draft, and reviewed and edited all subsequent versions of the manuscript; Kalra S, Goyal MK, and Goyal O performed the conceptualization and data validation; Goyal O performed the supervision of the study and visualization; Goyal MK and Goyal O contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors read and approved the final version of the manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Omesh Goyal, Professor, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana 141001, Punjab, India. dromeshgoyal@gmail.com

Received: July 17, 2025
Revised: August 18, 2025
Accepted: November 14, 2025
Published online: December 22, 2025
Processing time: 161 Days and 7 Hours

Core Tip

Core Tip: Gluten, once viewed solely as a gastrointestinal concern, is now implicated in a wide spectrum of hepatic disorders ranging from mild hypertransaminasemia to cirrhosis. Up to 40% of patients with celiac disease and 9% of those with unexplained elevated liver enzymes may have underlying gluten sensitivity. A gluten-free diet normalizes transaminase levels in most cases, yet long-term adherence may paradoxically exacerbate metabolic liver disease. This article elucidates the complex interplay between gluten, gut permeability, immune activation, and liver pathology. Recognizing gluten’s hepatic implications is crucial for early screening, tailored dietary management, and prevention of progressive liver injury in at-risk individuals.