P112 | Longitudinal improvement of liver stiffness in a patient with seronegative celiac disease and cryptogenic cirrhosis after gluten free diet initiation

Case report: A 45-years-old woman, without history of hepatic nor gastrointestinal diseases, presented to the emergency department with ascites and peripheral oedema associated with altered liver function tests (LFTs) and severe hypoalbuminemia, reporting a weight loss of 8 kg over the last year. Ultrasound showed mild signs of portal hypertension, while 2D-shear-wave-elastography (2D-SWE) demonstrated an increased liver stiffness (22.4 kPa) suggestive for cirrhosis. The patient denied alcohol intake, and was HBV/HCV negative, as well as tests for autoimmune liver diseases autoantibodies. She underwent upper GI endoscopy showing duodenal scalloping, and multiple duodenal biopsies revealed villous atrophy with increased intraepithelial lymphocytes (IELs) consistent with Marsh 3a stage. The patient tested negative for anti-tissue- transglutaminase IgA antibodies, whith normal IgA serum levels. Human Leukocyte Antigen (HLA) testing showed genetic susceptibility (DQ2) to celiac disease. Test for anti-enterocyte antibodies resulted negative. Gluten-free diet (GFD) was started, and after one year duodenal biopsies were reassessment revealed normal villous trophism and IELs count. 2D-SWE re-evaluations showed decreased liver stiffness (12.2 kPa after 1 year and 6.8 kPa after 2 years of strict GFD). Three years after the start of the GFD no episodes of decompensation nor alteration in LFTs were observed. Conclusions: In patients with cryptogenic cirrhosis, underlying CD, even seronegative, should be considered due to the potential improvement of the liver disease after starting GFD.