Celiac disease and liver

L and La Rosa (1) investigated the occurrence of celiac disease in patients with hepatitis B by screening their sera with anti-endomysial and anti-tissue transglutaminase antibodies—both of which are sensitive serological tests for celiac disease. The authors found no one with celiac disease in 60 patients who had contracted hepatitis B infection in childhood. As they admitted, the power of the study was too low to make any definitive conclusions. Celiac disease is defined as “a permanent intolerance to ingested gluten, the structural protein in wheat rye and barley.” The ingestion of gluten results in small bowel mucosal inflammation, crypt hyperplasia and villous atrophy. Typically, patients suffer from diarrhea, abdominal complaints, malaise, and malabsorption with resultant iron deficiency anemia. The histpathology and symptoms resolve on gluten-free diet. Of note, the condition is often asymptomatic. Extraintestinal manifestations or associated autoimmune conditions may be the sole presentations of celiac disease. Here, I disagree with Leonardi and La Rosa (1) who stated that associated autoimmune diseases are usually found in celiac patients with severe complications: existing autoimmune disorders (e.g., autoimmune hepatitis) may be the only disease manifestation in an otherwise asymptomatic celiac patient (2). Isolated hypertransaminasemia is common in celiac disease, and conversely, unexplained hypertransaminasemia may be a diagnostic clue in celiac disease. Celiac disease has been reported to occur in patients with primary biliary cirrhosis, autoimmune hepatitis and primary sclerosing cholangitis (3). Untreated celiac disease may exacerbate the associated liver disease, and gluten-free dietary treatment in such cases, may result in a dramatic improvement, even in advanced liver disease (4) . As to the viral hepatitis, there are more studies on the occurrence of celiac disease in hepatitis C than in hepatitis B. Two large studies comprising 624 (5) and 878 (6) patients with hepatitis C found no increased frequency of celiac disease. The positive associations are mainly based on case reports. When considering the reports, some facts must be taken into account. Firstly, celiac disease affects