L'epatopatia della malattia celiaca: Uno spettro di lesioni con una comune patogenesi?

A wide spectrum of liver injuries in children and adults may be related to celiac disease (CD) and in particular: 1) a mild parenchymal damage characterized by absence of clinical sign or symptom of a chronic liver disease and by non-specific histological changes reversible on a gluten-free diet; 2) a chronic inflammatory liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis, which may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive treatment; 3) a severe liver failure potentially treatable by a gluten-free diet. Such different types of liver injuries may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, precocity and duration of exposure to gluten may influence the reversibility of liver damage. A rigorous cross-checking for an asymptomatic liver damage in CD individuals and, conversely, for CD in any cryptogenic liver disorder including end-stage liver failure is recommended.