Is coeliac disease a confounding factor in the diagnosis of NASH?
- Institute of Internal Medicine
- Policlinico Universitario A Gemelli
- Catholic University of Sacred Heart, Rome, Italy
- Dr A Grieco, Institute of Internal Medicine, Catholic University of Sacred Heart, Largo Gemelli 8—00168 Rome, Italy.
Editor,—We read with great interest the paper by Wigg et al(
) concerning the role of small intestinal bacterial overgrowth in the pathogenesis of non-alcoholic steatohepatitis (NASH) but we would like to comment on the enrolment criteria used for their study. We agree with Farrell (
) that the Adelaide group's failure to characterise the variables of obesity and diabetes in their population might result in selection bias. Moreover, they made no attempt to exclude the possibility of coeliac disease (CD) which can also be associated with altered intestinal permeability even when the disease is subclinical.1
In approximately 40% of all adults with this disease, increased serum transaminase levels are found at diagnosis,2 and such elevations may be the only abnormality in cases of “occult” CD.3 In fact, in a study by Bardellaet al, 9.3% of cases of unexplained chronic hypertransaminasaemia were ultimately diagnosed as CD.4
From December 1997 to December 1999, we observed 30 subjects …