Hepatic abnormalities in coeliac disease: three cases of delayed diagnosis

Three cases of biopsy-proven coeliac disease are presented. In each case the predominant clinical and laboratory features suggested liver disease, bowel symptoms were a minor part of the presentation and the diagnosis of coeliac disease was not reached for approximately 6 months. Liver biopsy in one case showed marked fatty change, in the other cases only mild hepatitic changes. A gluten-free diet produced resolution of symptoms and, in the patient with steatosis, normalization of liver function tests. Hepatic abnormalities have been reported in coeliac disease and the significance of these is discussed but such abnormalities are usually minor and do not obscure the underlying diagnosis. We feel that these cases serve as a salutary reminder of the protean manifestations of coeliac disease.