Severe hepatopathy and celiac disease

Of a total of 248 cases of celiac disease observed in our department, 78 cases (31.5%) had chronic associated liver disease, including 05 cases of severe liver disease. There are 3 women and 2 men with a sex ratio F/H of 1.5, the average age was 35 years [25-57]. The diagnosis of celiac disease was made before the appearance of chronic liver disease in 04 patients with an average delay of 9.5 years, whereas only one patient had a chronic liver disease diagnosed 05 years before the discovery of celiac disease. The reason for consultation was mainly malabsorption diarrhoea (5 cases). The physical examination found a syndrome of portal hypertension in 3 cases and is normal in 2 cases. In the biology, there was anaemia in 4 cases including one case of pan cytopenia, one hepatic cytolysis in 4 cases. The abdominal ultrasound showed a chronic hepatic appearance +/sign of HTP in 4 cases and normal in one case. The etiological balance of cytolysis was negative (B, C, autoimm, overload). Upper digestive endoscopy showed a rarefaction of duodenal folds in 3 cases, with signs of HTP in all patients. The histopathological study of the biopsies showed intraepithelial lymphocytosis > 30% with villous atrophy in all patients. Antitransglutaminase antibodies were positive in 04 patients and negative in 01 cases. The liver biopsy puncture showed severe fibrosis (F3) in 03 cases and cirrhosis (F4) in 2 cases. All our patients are on gluten-free diet, with symptomatic treatment of portal hypertension. The evolution was marked by a stabilization of chronic liver disease and its complications. One case presented ascitic decompensation for poor compliance with the glutenfree diet. No case of CHC has been noted in our series.