Is an atypical presentation becoming typical of coeliac disease?

A 38-year-old woman was referred to a gastroenterology clinic for investigation of abnormal liver function test (LFT). She had no history of pre-existing liver disease, diabetes mellitus, hypertension, excess alcohol consumption or use of any hepatotoxic drugs. She was being investigated and treated by oral surgeons for recurrent mouth ulcers which she had for about 18 months. She had been seen by the rheumatology team for pain and early morning stiffness affecting the peripheral small joints. Clinical examination was unremarkable apart from the presence of an increased body mass index of 36 kg/m(2). Her haematological and biochemical profile including liver screen did not reveal any abnormalities. Her anti-endomyseal antibody and duodenal biopsies were consistent with the diagnosis of coeliac disease. Her LFT returned to normal within 3 months of starting on a gluten-free diet and remained normal over the next 12 months. She also remained free of mouth ulcers during this period.