Liver injury in coeliac disease.

Coeliac disease is a gluten-sensitive enteropathy in which, genetic, immuno logic and environmental factors are implied. Several extradigestive disease s have been described in association with coeliac disease, which share most of the times an immunologic mechanism. The liver is damaged in coeliac dis ease, and it has been considered by some authors as an extraintestinal mani festation of the disease. In the present revision we discuss the different hepatic diseases related with the coeliac disease, as well as the best appr oach to diagnosis and therapy of choice. At diagnosis, it is very frequent to find an asymptomatic hipertransaminase mia, which frequently disappears after gluten suppression; the morphologica l substratum found in this alteration is a non-specific reactive hepatitis in the majority of cases. Coeliac disease is a demonstrated cause of crypto genic hipertransaminasemia. In a small percentage of patient with coeliac diasease an association has b een found with other immunological liver diseases, such as primary biliary cirrhosis, primary sclerosing cholangitis and autoinmune hepatitis. Few stu dies exist that include a large number of patient, and the results on occas ions are discordants. Nevertheless, the strongest association is with autoi nmune hepatitis and with primary biliary cirrhosis. Several communications of isolated cases of rave hepatic diseases, which probably, only reflect a fortuitous association, have been cited in the literature.