Clinical ResearchCeliac disease in patients with severe liver disease: Gluten-free diet may reverse hepatic failure☆,☆☆
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Celiac disease in patients with severe liver failure
Four patients with severe liver failure who were found to have celiac disease are described in detail. These patients were placed on a gluten-free diet, and clinical recovery of the liver disease was observed.
All liver transplantations in Finland, altogether 375 so far, are performed at Helsinki University Hospital. Local specialist centers refer patients for consideration when patients seem to approach end-stage liver disease. Three of 4 patients subsequently found to have celiac disease were
Case 1
In 1984, a 15-year-old white boy was examined because of a history of iron deficiency anemia. He did not have any abdominal symptoms, but his growth had been slightly retarded at 5 years of age. A small bowel mucosal biopsy specimen showed villous atrophy with crypt hyperplasia consistent with celiac disease. The prescribed gluten-free diet resulted in immediate clinical recovery, but for some reason shortly thereafter the patient neglected the diet and surveillance.
Five years later, in 1989,
Discussion
Here we describe 4 patients with advanced liver disease who were found to have celiac disease. Three of these patients were remitted as possible candidates for liver transplantation. It is impossible in retrospect to envisage the possible outcome of liver disease in the absence of a gluten-free diet. Nevertheless, the liver disease improved significantly in every case after adoption of the diet, and the favorable effect was sustained in the 2 patients who continued on a strict diet.
On the other
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Address requests for reprints to: Pekka Collin, M.D., Medical School, FIN-33014 University of Tampere, Tampere, Finland. e-mail: [email protected]; fax: (358) 3-215-8402.
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Supported by the Medical Research Fund of Tampere University Hospital, the Emil Aaltonen Foundation, the Sigrid Juselius Foundation, the Medical Research Fund of Finnish Red Cross Blood Transfusion Service, and the Academy of Finland (grant 51547 to K.K.).