title: Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.
abstract: OBJECTIVE
  Mild liver abnormalities are common in patients with celiac disease and usually resolve with a gluten-free diet. We investigated the occurrence of celiac disease in patients with severe liver failure.
  
  
  METHODS
  Four patients with untreated celiac disease and severe liver disease are described. Further, the occurrence of celiac disease was studied in 185 adults with previous liver transplantation using serum immunoglobulin A endomysial and tissue transglutaminase antibodies in screening.
  
  
  RESULTS
  Of the 4 patients with severe liver disease and celiac disease, 1 had congenital liver fibrosis, 1 had massive hepatic steatosis, and 2 had progressive hepatitis without apparent origin. Three were even remitted for consideration of liver transplantation. Hepatic dysfunction reversed in all cases when a gluten-free diet was adopted. In the transplantation group, 8 patients (4.3%) had celiac disease. Six cases were detected before the operation: 3 had primary biliary cirrhosis, 1 had autoimmune hepatitis, 1 had primary sclerosing cholangitis, and 1 had congenital liver fibrosis. Only 1 patient had maintained a long-term strict gluten-free diet. Screening found 2 cases of celiac disease, 1 with autoimmune hepatitis and 1 with secondary sclerosing cholangitis.
  
  
  CONCLUSIONS
  The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Kaukinen
authors.forename: Leena
authors.initials: L
authors.lastname: Halme
authors.forename: Pekka
authors.initials: P
authors.lastname: Collin
authors.forename: Martti
authors.initials: M
authors.lastname: Färkkilä
authors.forename: Markku
authors.initials: M
authors.lastname: Mäki
authors.forename: Paula
authors.initials: P
authors.lastname: Vehmanen
authors.forename: Jukka
authors.initials: J
authors.lastname: Partanen
authors.forename: Krister
authors.initials: K
authors.lastname: Höckerstedt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000178:diet therapy* / Q000453:epidemiology* / Q000235:genetics; D002675:Child, Preschool; D004032:Diet; D005260:Female; D005983:Glutens / Q000009:adverse effects; D006683:HLA-DQ Antigens / Q000235:genetics; D019693:Hepatitis, Autoimmune / Q000178:diet therapy / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D017093:Liver Failure / Q000178:diet therapy* / Q000453:epidemiology* / Q000235:genetics; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D006683:HLA-DQ Antigens; C053186:HLA-DQ2 antigen; C109756:HLA-DQ8 antigen; D005983:Glutens