[Liver abnormalities in adult celiac disease. Clinicopathologic characterization and outcome after therapy]. / Alteraciones hepáticas en la enfermedad celíaca del adulto. Caracterización clínico-patológica y evolución.

BACKGROUND AND AIM: The clinical manifestations of adult celiac disease are highly varied and may include liver disease. The present study aimed to characterize liver abnormalities and outcome after a gluten-free diet in patients with celiac disease diagnosed in a hepatology clinic. MATERIAL AND METHOD: The clinical records of patients diagnosed with celiac disease during a 7-year period were reviewed. RESULTS: Of 1916 patients attending a first consultation at the clinic, 10 were finally diagnosed with celiac disease. All patients had been referred for evaluation of persistent elevation of liver enzyme levels. All patients were young (mean age 30 years, range 21-39 years) and there were more women than men (eight women, 80%). Six patients (60%) had additional manifestations attributable to undiagnosed celiac disease, sometimes since childhood. In all patients, elevation of liver enzyme levels was moderate and overall liver function was preserved. Liver biopsy was performed in five patients and all showed chronic periportal infiltrate. Immunohistochemical studies revealed that the infiltrate was mainly composed of CD8-positive T lymphocytes. In all patients, a gluten-free diet was followed by normalization of liver enzyme levels. CONCLUSIONS: Although celiac disease is not highly frequent, it should be considered in the differential diagnosis of patients with persistent abnormalities of liver markers. The most conspicuous histopathological change is periportal T-cell infiltrate. Liver abnormalities in celiac disease are generally mild and improve after a gluten-free diet.

Alteraciones hepáticas en la enfermedad celíaca del adulto. Caracterización clínico-patológica y evolución / Liver abnormalities in adult celiac disease. Clinicopathologic characterization and outcome after therapy

Introducción y objetivo: Las manifestaciones clínicas de la enfermedad celíaca del adulto son muy variadas y pueden incluir alteraciones hepáticas. El objetivo del presente estudio fue caracterizar las alteraciones hepáticas y su evolución con el tratamiento de los pacientes celíacos diagnosticados en una consulta de hepatología. Material y método: Revisión de los historiales clínicos de los pacientes adultos finalmente diagnosticados de enfermedad celíaca en un período de 7 años. Resultados: De un total de 1.916 pacientes adultos vistos por primera vez en dicha consulta, 10 pacientes fueron finalmente diagnosticados de enfermedad celíaca. Todos habían sido remitidos por elevación persistente de enzimas hepáticas. Todos eran jóvenes (edad media, 30 años; intervalo, 21-39 años) y con predominio de mujeres (8 casos; 80%); 6 pacientes (60%) habían presentado clínica atribuible a la enfermedad celíaca (no diagnosticada), a veces desde su infancia. En todos los casos la elevación de enzimas hepáticas era moderada y la función hepática de síntesis estaba conser vada. En la biopsia hepática (de los 5 pacientes en que fue realizada) se observó un infiltrado inflamatorio crónico periportal a expensas de linfocitos T mayoritariamente CD8+. La supresión del gluten de la dieta consiguió normalizar los valores de las enzimas hepáticas en todos los casos. Conclusiones: A pesar de que en general no es muy frecuente, se debe tener en cuenta la enfermedad celíaca en el diagnóstico diferencial de las alteraciones persistentes de la biología hepática en el adulto. El hallazgo histopatológico más constante es el infiltrado periportal por linfocitos T. La dieta sin gluten normaliza dichas alteraciones, que suelen ser escasamente graves

Background and aim: The clinical manifestations of adult celiac disease are highly varied and may include liver disease. The present study aimed to characterize liver abnormalities and outcome after a gluten-free diet in patients with celiac disease diagnosed in a hepatology clinic. Material and method: The clinical records of patients diagnosed with celiac disease during a 7-year period were reviewed. Results: Of 1916 patients attending a first consultation at the clinic, 10 were finally diagnosed with celiac disease. All patients had been referred for evaluation of persistent elevation of liver enzyme levels. All patients were young (mean age 30 years, range 21-39 years) and there were more women than men (eight women, 80%). Six patients (60%) had additional manifestations attributable to undiagnosed celiac disease, sometimes since childhood. In all patients, elevation of liver enzyme levels was moderate and overall liver function was preserved. Liver biopsy was performed in five patients and all showed chronic periportal infiltrate. Immunohistochemical studies revealed that the infiltrate was mainly composed of CD8-positive T lymphocytes. In all patients, a gluten-free diet was followed by normalization of liver enzyme levels. Conclusions: Although celiac disease is not highly frequent, it should be considered in the differential diagnosis of patients with persistent abnormalities of liver markers. The most conspicuous histopathological change is periportal T-cell infiltrate. Liver abnormalities in celiac disease are generally mild and improve after a gluten-free diet

Alteraciones hepáticas en la enfermedad celíaca del adulto. Caracterización clínico-patológica y evolución / Liver abnormalities in adult celiac disease. Clinicopathologic characterization and outcome after therapy

Introducción y objetivo: Las manifestaciones clínicas de la enfermedad celíaca del adulto son muy variadas y pueden incluir alteraciones hepáticas. El objetivo del presente estudio fue caracterizar las alteraciones hepáticas y su evolución con el tratamiento de los pacientes celíacos diagnosticados en una consulta de hepatología. Material y método: Revisión de los historiales clínicos de los pacientes adultos finalmente diagnosticados de enfermedad celíaca en un período de 7 años. Resultados: De un total de 1.916 pacientes adultos vistos por primera vez en dicha consulta, 10 pacientes fueron finalmente diagnosticados de enfermedad celíaca. Todos habían sido remitidos por elevación persistente de enzimas hepáticas. Todos eran jóvenes (edad media, 30 años; intervalo, 21-39 años) y con predominio de mujeres (8 casos; 80%); 6 pacientes (60%) habían presentado clínica atribuible a la enfermedad celíaca (no diagnosticada), a veces desde su infancia. En todos los casos la elevación de enzimas hepáticas era moderada y la función hepática de síntesis estaba conser vada. En la biopsia hepática (de los 5 pacientes en que fue realizada) se observó un infiltrado inflamatorio crónico periportal a expensas de linfocitos T mayoritariamente CD8+. La supresión del gluten de la dieta consiguió normalizar los valores de las enzimas hepáticas en todos los casos. Conclusiones: A pesar de que en general no es muy frecuente, se debe tener en cuenta la enfermedad celíaca en el diagnóstico diferencial de las alteraciones persistentes de la biología hepática en el adulto. El hallazgo histopatológico más constante es el infiltrado periportal por linfocitos T. La dieta sin gluten normaliza dichas alteraciones, que suelen ser escasamente graves

Background and aim: The clinical manifestations of adult celiac disease are highly varied and may include liver disease. The present study aimed to characterize liver abnormalities and outcome after a gluten-free diet in patients with celiac disease diagnosed in a hepatology clinic. Material and method: The clinical records of patients diagnosed with celiac disease during a 7-year period were reviewed. Results: Of 1916 patients attending a first consultation at the clinic, 10 were finally diagnosed with celiac disease. All patients had been referred for evaluation of persistent elevation of liver enzyme levels. All patients were young (mean age 30 years, range 21-39 years) and there were more women than men (eight women, 80%). Six patients (60%) had additional manifestations attributable to undiagnosed celiac disease, sometimes since childhood. In all patients, elevation of liver enzyme levels was moderate and overall liver function was preserved. Liver biopsy was performed in five patients and all showed chronic periportal infiltrate. Immunohistochemical studies revealed that the infiltrate was mainly composed of CD8-positive T lymphocytes. In all patients, a gluten-free diet was followed by normalization of liver enzyme levels. Conclusions: Although celiac disease is not highly frequent, it should be considered in the differential diagnosis of patients with persistent abnormalities of liver markers. The most conspicuous histopathological change is periportal T-cell infiltrate. Liver abnormalities in celiac disease are generally mild and improve after a gluten-free diet