[Adults celiac disease--the tip of the iceberg]. / Choroba trzewna u doroslych--wierzcholek góry lodowej.

In recent years the clinical course of celiac disease (CD; gluten enteropathy) has changed. It has been diagnosed more and more frequently in adults. Celiac disease in adults may manifest itself as active, silent, latent and late onset. To confirm the diagnosis of CD the most important is the result of jejunal mucosa biopsy and the presence of anti-endomysium, anti-reticuline and/or anti-tissue transglutaminase IgA antibodies in serum. All the patients with CD should be recommended a gluten free diet. In some cases, resistant to gluten free diet, the immunosuppressive therapy may be taken into consideration.

Sclerosing cholangitis associated with retroperitoneal fibrosis: a case of multisystem fibroinflammatory disorder.

INTRODUCTION: Retroperitoneal fibrosis is a fibroinflammatory disease of unknown etiology that can be associated with other fibroinflammatory disorders. Lately, there have been several reports showing that retroperitoneal fibrosis is a manifestation of IgG4-related sclerosing disease, which often presents as autoimmune pancreatitis. CASE REPORT: This report shows the case of IgG4-related sclerosing cholangitis associated with retroperitoneal fibrosis independent of autoimmune pancreatitis. The patient presented with cholestatic jaundice and picture of sclerosing cholangitis in endoscopic retrograde cholangiography. The combination of endoscopic biliary drainage and steroid therapy was an effective treatment in this case. CONCLUSION: The diagnosis of IgG4-related sclerosing disease should always be taken into consideration in patients with sclerosing cholangitis, especially when it is associated with any fibroinflammatory disorder.