Hepatic disease, the gastrointestinal tract, and rheumatic disease

In previous years, this review concentrated on the relationship between pathology in the gastrointestinal tract and rheumatologic complaints associated with this pathology. This year, we have emphasized the relationship between hepatic disorders and rheumatologic complaints, although a resumé of recent literature pertaining to the gastrointestinal tract and its rheumatologic consequences is also presented. We believe it is necessary to divert our primary focus of attention because of recent developments in identifying the extrahepatic effects of hepatitis C infection and the current interest in abnormalities of drug metabolism in various rheumatic and autoimmune disorders. These recent developments bring us full circle in incriminating not only bacterial and dietary antigens in the pathogenesis of the spondyloarthropathies but also viruses and exogenous chemicals as potential etiologic agents in genetically predisposed hosts, resulting in the development of a variety of diseases, including glomerulonephritis, vasculitis, Sjögren's syndrome, and systemic lupus erythematosus.