Gluten-free diet in chronic active hepatitis associated with intestinal villous atrophy

Three patients out of 16 with chronic active hepatitis exhibited villous atrophy in biopsy specimens from the upper jejunum. These patients were put on a gluten-free diet for one year, and the intestinal changes normalized in two of the patients, but did not heal in the third patient. The levels of alanine aminotransferase and IgG, did not decrease under the gluten-free diet. The liver disease of the patients with intestinal changes ran a serious course: one patient died in hepatic coma, and one patient developed portal hypertension with recurring hematemesis. These complications did not appear in the patients with healthy intestine. It is suggested that the three patients suffered from both chronic active hepatitis and coeliac disease, which appeared concomitantly on the basis of a genetic disposition for both diseases.