Caerulein induced pancreatitis.

LETTERS Osteoporosis and liver disease: additional reasons for coeliac disease screening We read with great interest the recently published guidelines on the management of osteoporosis associated with chronic liver disease (Gut 2002;50(suppl I):i1–9). However, we would like to add a few words of comment. Associations between coeliac disease (CD) and primary biliary cirrhosis in particular and other autoimmune liver diseases in general have been reported. 1–3 In addition, it has been suggested that these individuals should be considered as an at risk group for whom sero-logical testing for CD is indicated. 1 Patients with CD are at high risk of developing low bone mineral density and bone turnover impairment, 1 and it has been shown that adherence to a gluten free diet has a significant positive impact on these parameters. 4 Thus we suggest that physicians caring for patients with the above mentioned liver diseases should screen them for CD in the presence of signs and symptoms suggestive of malabsorption such as osteoporosis. This seems a reasonable strategy as detection of CD will allow for a more rational therapeutic approach to the risks determined by this association. Complications due to the presence of CD, such as malnutrition, anaemia, and osteoporosis, may have a considerable impact on liver disease management and the need/success of transplantation. References 1 Fasano A, Catassi C. Current approaches to diagnosis and treatment of celiac disease: An evolving spectrum. Autoimmune cholangitis in a patient with celiac disease: a case report and review of the literature. Society of Gastroenterology. Guidelines for osteoporosis in coeliac disease and inflammatory bowel disease. Gut 2000;46(suppl I):i1–8. 5 Metcalf J. Coeliac disease and primary biliary cirrhosis: a case for mutual screening. We have read with interest the article by Fros-sard et al (Gut 2002;50:78–83) entitled " Both thermal and non-thermal stress protect against caerulein induced pancreatitis and prevent trypsinogen activation in the pan-creas ". We have a few comments with regard to the interpretation of the data that were obtained in this experiment. Previous experimental work by Frossard and others have implicated HSP70 as playing a protective role in caerulein induced acute pancreatitis. In the present study Frossard et al showed that thermal and non-thermal stress induced by injection of the β agonist isopro-terenol upregulated HSP70 in the pancreas which is associated with amelioration of subsequently induced caerulein pancreatitis. The authors hypothesise that the protective effects on pancreatitis severity caused by thermal and …