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Letter
Osteoporosis and liver disease: additional reasons for coeliac disease screening
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  1. M Marignani,
  2. S Angeletti,
  3. S Morini
  1. Department of Gastroenterology and Hepatology, S Giacomo Hospital, Via A Canova 29, 00186 Rome, Italy
  1. Correspondence to:
    Dr M Marignani, Via G Donizetti 6, 00041 Albano Laziale, Rome, Italy;
    mmarignani{at}hotmail.com

http://dx.doi.org/10.1136/gut.52.3.452

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    We read with great interest the recently published guidelines on the management of osteoporosis associated with chronic liver disease (

    Gut2002;50(suppl I):i1–9
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    ). However, we would like to add a few words of comment. Associations between coeliac disease (CD) and primary biliary cirrhosis in particular and other autoimmune liver diseases in general have been reported.1–3 In addition, it has been suggested that these individuals should be considered as an at risk group for whom serological testing for CD is indicated.1 Patients with CD are at high risk of developing low bone mineral density and bone turnover impairment,1 and it has been shown that adherence to a gluten free diet has a significant positive impact on these parameters.4 Thus we suggest that physicians caring for patients with the above mentioned liver diseases should screen them for CD in the presence of signs and symptoms suggestive of malabsorption such as osteoporosis. This seems a reasonable strategy as detection of CD will allow for a more rational therapeutic approach to the risks determined by this association. Complications due to the presence of CD, such as malnutrition, anaemia, and osteoporosis, may have a considerable impact on liver disease management and the need/success of transplantation.5,6

    References

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      Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Gastroenterology2001;120:636–51.
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    2. Gogos CA, Nikolopoulou V, Zolota V, et al. Autoimmune cholangitis in a patient with celiac disease: a case report and review of the literature. J Hepatol1999;30:321–4.
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      Heathcote EJ. Management of primary biliary cirrhosis. Hepatology2001;31:1005–13.
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      Scott EM, Gaywood I, Scott BB, for the British Society of Gastroenterology. Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut2000;46(suppl I):i1–8.
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    5. ↵
      Metcalf J. Coeliac disease and primary biliary cirrhosis: a case for mutual screening. Gut1998;42:9–10.
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    6. ↵
      Neuberger J. PBC and the gut: the villi atrophy, the plot thickens. Gut1999;44:594–5.
      OpenUrlFREE Full Text

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