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PBC and the gut: the villi atrophy, the plot thickens
  1. Liver Unit,
  2. Queen Elizabeth Hospital,
  3. Birmingham B15 2TH, UK
  4. email

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See article on page 736

An association between primary biliary cirrhosis (PBC) and coeliac disease now seems well established. Since the original description by Logan and colleagues,1 there have been several reports indicating an association and these have been strengthened by larger epidemiological studies.2-11 In this issue (see page 736), Sørensen and colleagues publish their analysis of the prevalence of PBC in two populations of patients with coeliac disease, and confirm the association with a standardised incidence ratio of PBC in patients with coeliac disease of about 26. That separate evaluation of the two populations, Danes and Swedes (two countries with very different prevalences of coeliac disease), gave similar incidence ratios is strong evidence for a real association. If for no other reason, this paper deserves widespread recognition because it highlights the clinical insights that come from accurate and complete national morbidity and mortality registers. We in the United Kingdom would do well to learn from the Scandinavian example.

Last year Kingham and Parker showed, in a well defined population in Swansea, South Wales, that the prevalence of PBC in those followed for coeliac disease was 3% and the prevalence of coeliac disease in those with PBC was 6%.11 In Northern Ireland, routine screening of 67 patients with PBC showed that 11% had IgA endomysial antibodies and of these, four agreed to have a duodenal biopsy which showed villous atrophy, giving a minimum prevalence rate of 7%.8These figures are considerably higher than those given by Sorensenet al who found 24 cases of PBC (0.3%) among 8631 coeliac patients followed in the Danish and Swedish populations. This 10-fold discrepancy between the Welsh and Scandinavian data may in part be due to real …

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