Clinical features of chronic C virus hepatitis in patients with celiac disease

The association between celiac disease (CD) and several liver disorders has long been documented. About 40% of adult celiac patients have been reported to have mild to moderate hypertransaminasemia (up to five times the upper limit of normal) at the time of diagnosis of CD [1, 2]. In addition, CD has been found in roughly 10% of patients with unexplained hypertransaminasemia, and the majority of them have had their liver enzyme levels normalized after one year of following a strict gluten-free diet [3, 4]. In addition, an increased prevalence of primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis among CD patients has been reported [5, 6]. CD might also be linked to very severe liver conditions such as end-stage liver failure and hepatocellular carcinoma [7]. There is also evidence, even contrasting reports, about the association of CD with nonalcoholic steatohepatitis and fatty liver disease [8]. In contrast, no definitive evidence is available about the association between chronic hepatitis C (hepatitis C virus [HCV]) and CD. Fine et al. described a three-fold increase of CD prevalence among HCV patients compared to noninfected celiac individuals [9]. It has also been reported the activation of silent CD during the antiviral treatment for HCV with interferon-α and ribavirin, both alone and in combination [10]. Consequently, a routine serological screening for CD has been proposed in HCV patients before starting antiviral therapy. In case of HCV positivity, the achievement of the histological normalization of the intestinal mucosa after following a gluten-free diet has been advised before starting the therapy [10].