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Abstract

We thank Dr. Marignani and his colleagues for their interest in our article [ [1] Bardella M.T. Valenti L. Pagliari C. Peracchi M. Farè M. Fracanzani A.L. et al. Searching for coeliac disease in patients with non-alcoholic fatty liver disease. Dig Liver Dis. 2004; 36: 333-336 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar ]. We would like to pinpoint that histology of our patients with NAFLD was examined by the same pathologist, trained in hepatic histology. On the contrary, in the previous study published in 1999 [ [2] Bardella M.T. Vecchi M. Conte D. Del Ninno E. Fraquelli M. Pacchetti S. et al. Chronic unexplained hypertransaminasemia may be caused by occult celiac disease. Hepatology. 1999; 29: 654-657 Crossref PubMed Scopus (168) Google Scholar ], we recruited patients from three different centres for liver disease and liver biopsies were available in only 9 out of 13 CD patients. Histology showed the presence of minimal changes in six cases, microvesicular steatosis in two, macrovesicular steatosis and portal piecemeal necrosis in one. Regarding Nehra et al.'s [ [3] Nehra V. Angulo P. Buchman A.L. Lindor K.D. Nutritional and metabolic considerations in the etiology of nonalcoholic steatohepatitis. Dig Dis Sci. 2001; 46: 2347-2352 Crossref PubMed Scopus (136) Google Scholar ] study on the relationships between CD and NAFLD, it is worth noting that, despite our series is rather different having more males than females (56 M/6 F), lower BMI (mean 27.5 ± 3.3) and NASH prevalence of 64%, the prevalence of CD is quite similar (3.4% versus 2.1%). Contrary to Nehra et al., we believe that a six-fold increase in the prevalence of CD in patients with NAFLD compared with that of the general population, should not be underestimated. Thus, it is possible to confirm that a certain percentage of NAFLD/NASH is associated with CD whereas the role of CD in determining the severity of the liver damage is questionable. Coeliac disease and non-alcoholic fatty liver diseaseDigestive and Liver DiseaseVol. 36Issue 11PreviewWe read with interest the paper by Bardella et al. [1] recently published in Digestive and Liver Disease on coeliac disease (CD) and non-alcoholic fatty liver disease (NAFLD). The authors suggest that CD may represent a possible risk factor for the development of NAFLD. The observed increased prevalence of CD in NAFLD patients and the physiopathological explanations discussed are intriguing. Nevertheless, other authors strongly argue that CD should not be considered as a cause of NAFLD [2], since most CD patients with elevated aminotransferases show only non-specific reactive hepatitis. Full-Text PDF