Jennifer Esposito’s liver was failing. The Blue Bloods actress — who went years without a celiac disease diagnosis — has revealed just how close she came to serious organ failure before anyone gave her the right answer. New reporting from Cleveland.com covers her account, and it adds a critical dimension to an already alarming misdiagnosis story: celiac disease doesn’t confine itself to the gut. Left untreated, it can take the liver down with it.
As a celiac parent, I follow stories like Esposito’s not for the celebrity angle but because they put a face on a pattern that too many families experience. We’ve previously covered how Esposito was sent to a psychiatric ward amid severe health problems — doctors unable to explain her symptoms, dismissing them as psychological. The liver failure detail extends that account and points to something the celiac community has understood for years: by the time celiac disease gets diagnosed, the damage can reach far beyond the small intestine.
What This Means for You
Celiac disease is usually described as an intestinal condition, but it’s a systemic autoimmune disease. When gluten triggers the immune response in a celiac patient, that response doesn’t stop at the intestinal wall. The liver — which filters everything absorbed through the gut — takes a hit too.
Elevated liver enzymes are one of the more common but consistently overlooked signs of undiagnosed celiac. Studies suggest that somewhere between 40 and 60 percent of untreated celiac patients show abnormal liver function tests. In most cases, those numbers return to normal within six to twelve months of strict gluten removal. But doctors rarely think to test for celiac when they see elevated enzymes — and that gap can cost patients years.
Esposito’s account represents the far end of what that gap can produce. Liver damage accumulates quietly. A person can feel profoundly unwell, show up in a doctor’s office with abnormal blood work, and still leave without a celiac diagnosis because no one connected the dots. That failure isn’t rare — it reflects a systemic blind spot in how celiac disease gets recognized outside its classic presentation.
For celiac families and for anyone still searching for a diagnosis, this has real practical weight. When a doctor finds elevated liver enzymes without an obvious cause, celiac disease belongs on the list of possibilities — especially alongside fatigue, gastrointestinal complaints, or other unexplained symptoms. The test is a simple blood draw. Ask for it by name if your doctor hasn’t offered it.
Key Takeaways
- Celiac disease is systemic — it can damage the liver, not just the small intestine.
- Elevated liver enzymes appear in an estimated 40–60% of untreated celiac patients.
- Those enzyme levels typically normalize within six to twelve months on a strict gluten-free diet.
- Jennifer Esposito’s liver was reportedly failing before she received a celiac diagnosis.
- Unexplained liver abnormalities, especially alongside other symptoms, should prompt celiac testing.
The Science
Want to understand how this actually works? We’ll walk you through the technical details below and define every term. No medical degree required.
How Celiac Disease Reaches the Liver
Celiac hepatitis — liver inflammation caused by undiagnosed celiac disease — is well documented in medical research, even if it rarely comes up in a routine clinical encounter. Researchers have identified two main pathways through which celiac triggers liver damage.
The first involves intestinal permeability, the breakdown of the gut lining’s filtering barrier. In active celiac disease, the immune attack on the small intestine damages the tight junctions between intestinal cells — the microscopic seals that normally keep gut contents from leaking into the bloodstream. When those seals fail, bacterial toxins and other molecules pass through into the portal vein (the large blood vessel that carries nutrient-rich, gut-filtered blood directly to the liver). The liver responds with inflammation as it attempts to process an unusual load of harmful material it wasn’t meant to receive.
The second pathway is autoimmune. Celiac disease is not simply a food intolerance — the immune system genuinely misfires, targeting the body’s own tissue. In some patients, that misfiring extends to liver cells. This can produce autoimmune hepatitis (inflammation driven by the immune system attacking liver tissue), and celiac disease is associated with elevated rates of several serious liver conditions: primary biliary cholangitis (a chronic disease that progressively damages bile ducts inside the liver) and primary sclerosing cholangitis (scarring of the bile ducts that can eventually impair liver function). These conditions are not caused by celiac in every patient, but the overlap is real and documented.
What the Research Shows
Hypertransaminasemia — elevated levels of liver enzymes called transaminases, specifically ALT and AST (the standard markers on a basic metabolic panel or liver function test) — appears in a substantial share of celiac patients before diagnosis. Multiple studies and reviews put the figure at 40–60% of untreated adult patients. In children, the rate varies but remains significant.
The well-established response: strict adherence to a gluten-free diet normalizes those enzymes for most patients within six to twelve months. Clinicians sometimes use this normalization as a retrospective confirmation that celiac was driving the liver abnormality — the so-called gluten-free diet response. When enzymes drop to normal after removing gluten, the diagnosis is effectively confirmed in hindsight.
What Esposito’s account suggests is a case in which years without diagnosis allowed liver damage to accumulate well past the point of an abnormal blood test. That progression is an outlier in terms of severity, but it represents a real trajectory when celiac goes unrecognized for a long time.
Why Doctors Miss It
Non-classical celiac disease — presentations without the textbook triad of diarrhea, weight loss, and severe abdominal cramping — is actually more common than the textbook version. Liver involvement falls squarely into this category. A patient presenting with fatigue, unexplained weight changes, and elevated liver enzymes might cycle through a hepatologist (liver specialist), a gastroenterologist focused on liver conditions, or a general practitioner — none of whom may place celiac disease high on the list without prompting.
The screening test for celiac is straightforward and inexpensive: a tTG-IgA blood test (tissue transglutaminase IgA antibody test), which measures an immune marker elevated in most celiac patients. Current guidelines recommend screening for first-degree relatives of celiac patients and for individuals with certain autoimmune conditions. What those guidelines don’t yet include — though advocates have been pushing — is routine celiac screening for unexplained elevated liver enzymes.
That gap is exactly what Esposito’s story illuminates. Her account matters for the celiac community not as a celebrity feature but as evidence of how badly delayed diagnosis can compound. The more attention these extra-intestinal manifestations receive, the better the chances that the next patient with a failing liver and years of dismissed symptoms gets a blood test that changes everything.
If you or someone you love has persistent, unexplained liver abnormalities — especially alongside fatigue or gastrointestinal symptoms — raise celiac disease explicitly with your doctor. Ask whether the tTG-IgA test has been done. It’s a simple question that could reframe an entire diagnostic picture.
Related Coverage
References
- Cleveland.com — Blue Bloods star says liver was failing after years of misdiagnosis (August 12, 2026)
- Rubio-Tapia A, Murray JA. “The liver in celiac disease.” Hepatology. 2007;46(5):1650–1658.
- Celiac Disease Foundation — Non-Classical Symptoms of Celiac Disease