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Z Gastroenterol 2006; 44(5): 395-398
DOI: 10.1055/s-2006-926581
Kasuistik

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Portal Hypertension and Nodular Regenerative Hyperplasia in a Patient With Celiac Disease

Portale Hypertension und noduläre regenerative Hyperplasie bei einem Patienten mit SprueE. Biecker1 , J. Trebicka1 , H.-P Fischer2 , T. Sauerbruch1 , F. Lammert1
  • 1Department of Internal Medicine I, University Hospital Bonn
  • 2Department of Pathology, University Hospital Bonn
Further Information

Publication History

manuscript received: 24.11.2005

manuscript accepted: 24.1.2006

Publication Date:
10 May 2006 (online)

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Zusammenfassung

Die noduläre regenerative Hyperplasie (NRH) ist eine seltene Ursache des portalen Hochdrucks und oft mit Krankheiten des rheumatischen Formenkreises oder lymphoproliferativen Erkrankungen assoziiert. Wir schildern hier den Fall eines neunzehnjährigen Patienten mit Sprue und portaler Hypertension. In der Leberbiopsie zeigte sich eine NRH als Ursache des portalen Hypertonus. Weder eine Autoimmunkrankheit noch ein Defekt im Gerinnungssystem konnten als mögliche Ursache für die NRH gezeigt werden. Eine Leberbeteiligung im Rahmen der Sprue kommt relativ oft vor, das Auftreten einer NRH bei Zöliakie wurde dagegen bisher nur selten beschrieben. Wir diskutieren die mögliche Beziehung zwischen Zöliakie und NRH.

Abstract

Nodular regenerative hyperplasia (NRH) is an uncommon cause of portal hypertension. The disease is often associated with rheumatological or lymphoproliferative disorders. We report the case of a 19-year old patient with celiac disease and portal hypertension. Biopsy of the liver revealed NRH as the underlying cause. There were no signs of autoimmune diseases or defects in the coagulation system that might cause NRH. Celiac disease is often associated with liver abnormalities, but the association with NRH has rarely been described. We discuss the possible relationship of celiac disease and NRH.

Schlüsselwörter

Portale Hypertension - noduläre regenerative Hyperplasie - Sprue - Zöliakie

Key words

Portal hypertension - nodular regenerative hyperplasia - celiac disease

References

  • 1 Bardella M T, Fraquelli M, Quatrini M. et al . Prevalence of hypertransaminasemia in adult celiac patients and effect of gluten-free diet.  Hepatology. 1995;  22 833-836
    CrossrefPubMedGoogle Scholar
  • 2 Kaukinen K, Halme L, Collin P. et al . Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.  Gastroenterology. 2002;  122 881-888
    CrossrefPubMedGoogle Scholar
  • 3 Dickey W, McMillan S A, Callender M E. High prevalence of celiac sprue among patients with primary biliary cirrhosis.  J Clin Gastroenterol. 1997;  25 328-329
    CrossrefPubMedGoogle Scholar
  • 4 Hay J E, Wiesner R H, Shorter R G. et al . Primary sclerosing cholangitis and celiac disease. A novel association.  Ann Intern Med. 1988;  109 713-717
    PubMedGoogle Scholar
  • 5 Biecker E, Stieger M, Zimmermann A. et al . Autoimmune hepatitis, cryoglobulinaemia and untreated coeliac disease: a case report.  Eur J Gastroenterol Hepatol. 2003;  15 423-427
    PubMedGoogle Scholar
  • 6 Biecker E, Fischer H P, Strunk H. et al . Benign hepatic tumours.  Z Gastroenterol. 2003;  41 191-200
    Google Scholar
  • 7 Wanless I R. Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules.  Hepatology. 1990;  11 787-797
    CrossrefPubMedGoogle Scholar
  • 8 Stromeyer F W, Ishak K G. Nodular transformation (nodular “regenerative” hyperplasia) of the liver. A clinicopathologic study of 30 cases.  Hum Pathol. 1981;  12 60-71
    CrossrefPubMedGoogle Scholar
  • 9 Dachman A H, Ros P R, Goodman Z D. et al . Nodular regenerative hyperplasia of the liver: clinical and radiologic observations.  AJR Am J Roentgenol. 1987;  148 717-722
    CrossrefPubMedGoogle Scholar
  • 10 Patriarche C, Pelletier G, Attali P. et al . Ultrasonography, angiography, computed tomography and magnetic resonance in nodular regenerative hyperplasia of the liver: report of a pseudo-tumoral case.  Radiat Med. 1988;  6 111-114
    PubMedGoogle Scholar
  • 11 Trauner M, Stepan K M, Resch M. et al . Diagnostic problems in nodular regenerative hyperplasia (nodular transformation) of the liver. Review of the literature and report of two cases.  Z Gastroenterol. 1992;  30 187-194
    PubMedGoogle Scholar
  • 12 Trotter J F, Everson G T. Benign focal lesions of the liver.  Clin Liver Dis. 2001;  5 17-42
    Google Scholar
  • 13 Washington K, Lane K L, Meyers W C. Nodular regenerative hyperplasia in partial hepatectomy specimens.  Am J Surg Pathol. 1993;  17 1151-1158
    PubMedGoogle Scholar
  • 14 Nakanuma Y. Nodular regenerative hyperplasia of the liver: retrospective survey in autopsy series.  J Clin Gastroenterol. 1990;  12 460-465
    CrossrefPubMedGoogle Scholar
  • 15 Daniel F, Cadranel J F, Seksik P. et al . Azathioprine induced nodular regenerative hyperplasia in IBD patients.  Gastroenterol Clin Biol. 2005;  29 600-603
    PubMedGoogle Scholar
  • 16 Dumortier J, Boillot O, Chevallier M. et al . Familial occurrence of nodular regenerative hyperplasia of the liver: a report on three families.  Gut. 1999;  45 289-294
    PubMedGoogle Scholar
  • 17 Zhou H, Wolff M, Pauleit D. et al . Multiple macroregenerative nodules in liver cirrhosis due to Budd-Chiari syndrome. Case reports and review of the literature.  Hepatogastroenterology. 2000;  47 522-527
    PubMedGoogle Scholar
  • 18 Hillaire S, Bonte E, Denninger M H. et al . Idiopathic non-cirrhotic intrahepatic portal hypertension in the West: a re-evaluation in 28 patients.  Gut. 2002;  51 275-280
    CrossrefPubMedGoogle Scholar
  • 19 Perez R uiz F, Zea M endoza AC, Orte M artinez FJ. Antiphospholipid antibodies may play a role in pathogenesis of nodular regenerative hyperplasia of the liver.  Br J Rheumatol. 1990;  29 (suppl 2) 107
    PubMedGoogle Scholar
  • 20 Austin A, Campbell E, Lane P. et al . Nodular regenerative hyperplasia of the liver and coeliac disease: potential role of IgA anticardiolipin antibody.  Gut. 2004;  53 1032-1034
    CrossrefPubMedGoogle Scholar
  • 21 Riestra S, Dominguez F, Rodrigo L. Nodular regenerative hyperplasia of the liver in a patient with celiac disease.  J Clin Gastroenterol. 2001;  33 323-326
    CrossrefPubMedGoogle Scholar
  • 22 Collin P, Reunala T, Pukkala E. et al . Coeliac disease - associated disorders and survival.  Gut. 1994;  35 1215-1218
    PubMedGoogle Scholar
  • 23 Collin P, Salmi J, Hallstrom O. et al . High frequency of coeliac disease in adult patients with type-I diabetes.  Scand J Gastroenterol. 1989;  24 81-84
    PubMedGoogle Scholar
  • 24 Ventura A, Magazzu G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease. SIGEP Study Group for Autoimmune Disorders in Celiac Disease.  Gastroenterology. 1999;  117 297-303
    CrossrefPubMedGoogle Scholar
  • 25 Lerner A, Blank M, Lahat N. et al . Increased prevalence of autoantibodies in celiac disease.  Dig Dis Sci. 1998;  43 723-726
    CrossrefPubMedGoogle Scholar
  • 26 Loinaz C, Colina F, Musella M. et al . Orthotopic liver transplantation in 4 patients with portal hypertension and non-cirrhotic nodular liver.  Hepatogastroenterology. 1998;  45 1787-1794
    PubMedGoogle Scholar
  • 27 Dumortier J, Bizollon T, Scoazec J Y. et al . Orthotopic liver transplantation for idiopathic portal hypertension: indications and outcome.  Scand J Gastroenterol. 2001;  36 417-422
    PubMedGoogle Scholar
  • 28 Radomski J S, Chojnacki K A, Moritz M J. et al . Results of liver transplantation for nodular regenerative hyperplasia.  Am Surg. 2000;  66 1067-1070
    PubMedGoogle Scholar

Erwin Biecker, MD, PhD

Department of Internal Medicine I, University Hospital Bonn

Sigmund-Freud-Str. 25

53105 Bonn

Phone: ++ 49/2 28/2 87 55 07

Fax: ++ 49/2 28/2 87 46 98

Email: erwin.biecker@ukb.uni-bonn.de

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