Chronic Hepatitis Due to Gluten Enteropathy - a Case Report.

Authors:
Prof. Iskren Kotzev, MD, PhD
Prof. Iskren Kotzev, MD, PhD
Clinic of Gastroenterology
Professor
Gastroenterology and Hepatology
Varna | Bulgaria

Folia Med (Plovdiv) 2017 Jun;59(2):228-231

Department of Internal Medicine, Prof. Paraskev Stoyanov Medical University, Varna, Bulgaria

Background: Celiac disease is an immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals.

Case Description: A 45-year-old Caucasian woman presented with severe iron-deficient anemia and mild elevation of liver enzymes. Upper endoscopy was done in the context of evaluation of anemia, which revealed reduced duodenal folds and mosaic pattern of the mucosa, but also grade II esophageal varices and portal hypertensive gastropathy. Duodenal biopsy showed total villous atrophy, diffuse mainly lymphocytic infiltrate, presence of intra-epithelial lymphocytes. Serology test confirmed celiac disease by the typical pattern of high titer positive IgA and IgG antibodies to tissue transglutaminase. Liver biopsy was performed for staging and etiological evaluation, because laboratory screening ruled out common viral, metabolic and autoimmune liver disease. Liver morphology was consistent with chronic hepatitis without findings for extensive fibrosis. Our patient had poor dietary compliance, so we failed to established improvement of liver enzymes and resolution of anemia during follow-up.

Conclusions: We would like to stress on the diverse clinical manifestations of celiac disease and the importance of serologic screening with antibodies to tissue transglutaminase in differential diagnosis of chronic liver disease.

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Source
http://dx.doi.org/10.1515/folmed-2017-0025DOI Listing
June 2017
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References

(Supplied by CrossRef)
Chronic unexplained hypertransaminasemia may be caused by occult celiac disease
Bardella et al.
Hepatology 1999
Advances in diagnosis and management of celiac disease
Kelly et al.
Gastroenterology 2015
Prevalence and causes of abnormal liver function in patients with coeliac disease
Casella et al.
Liver Int 2013
Anti - tissue transglutaminase antibodies in patients with abnormal liver tests : is it always coeliac disease
Lo Iacono et al.
Am J Gastroenterol 2005
Prevalence of abnormal liver function tests in celiac disease and the effect of a gluten - free diet in the US population
Castillo et al.
Am J Gastroenterol 2015
Liver involvement in celiac disease
Rubio et al.
Minerva Med 2008
Autoimmune liver disease associated with celiac disease in childhood : a multicenter study
Caprai et al.
Clin Gastroenterol Hepatol 2008
Causes of death in patients with celiac disease in a population - based Swedish cohort
Peters et al.
Arch Intern Med 2003
Celiac disease and chronic liver disease : Is there a relationship
Singh et al.
Indian J Gastroenterol 2013
Liver involvement in pediatric celiac disease
Anania et al.
World J Gastroenterol 2015

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