PRIMARY SCLEROSING CHOLANGITIS AND CELIAC-DISEASE - BENEFICIAL EFFECTOF GLUTEN-FREE DIET ON THE LIVER

Objective: Description of a quadruple association of clinically asympt omatic auto-immune disorders in a 54-year-old man with haplotype HLA A 1 B8 DR3: primary sclerosing cholangitis, coeliac disease, ulcerative colitis and Hashimoto's thyroiditis. Treatment: Gluten-free diet over 14 months. Results: Normalization of the intestinal mucosa and spectac ular improvement of biochemical tests of cholestasis and of histologic al lesions of primary sclerosing cholangitis. Conclusion: This case re port suggests that primary sclerosing cholangitis is an immunologicall y mediated disease, probably triggered in genetically susceptible subj ects by toxic or infectious agents that might have access to biliary e pithelial cells through the altered barrier of the colon and/or the sm all bowel.