We thank Dr Pellicano for his interest in our study.1 Although the prevalence of clinically significant liver disease in patients with celiac disease is quite low,2 we agree that as many as 40% of patients with celiac disease may have elevated liver enzymes at the time of diagnosis. 3 Furthermore, some studies4,5 showed that celiac disease is responsible for abnormal liver tests among ≤10% of patients with cryptogenic hepatitis. However, most studies on abnormal liver function tests in celiac disease have studied patients who were already diagnosed with celiac disease, not those with undiagnosed celiac disease.