Celiac Disease More Prevalent in Multiple Sclerosis

[Guest guest]

Celiac disease is more prevalent in patients with multiple sclerosis (MS)

and their close relatives than in the general population, clinicians from

Spain report.

Increased efforts aimed at early detection and dietary treatment of celiac

disease among MS patients with tissue IgA–antitransglutaminase-2 antibodies

" are advisable, " they conclude in a report published online March 7 in *BMC

Neurology*.

" We have found a prevalence of celiac disease among MS patients that is 5 to

10 times higher compared with the general population all over the world,

which is between 1% and 2%, " said first study author Rodrigo, MD, from

the Gastroenterology Service, Hospital Universitario Central de Asturias, in

Oviedo, Spain.

Dr. Rodrigo and his colleagues note, however, that celiac disease is often

underdiagnosed and therefore underestimated.

" The practical point is to put these patients on a gluten-free diet and to

observe the improvement of the neurological disease over time, " he said in

an email to *Medscape Medical News*.

*Clinic Experience Fuels Study*

Dr. Rodrigo and his associates recently saw a 30-year-old female patient

with relapsing-remitting MS who developed abdominal pain with diarrhea and

weight loss. She was diagnosed as having celiac disease, put on a

gluten-free diet, and subsequently saw improvement not only in her digestive

symptoms but also in her neurologic disturbances.

This experience led them to analyze the prevalence of serologic, histologic,

and genetic celiac disease markers in 72 MS patients and 126 first-degree

relatives, as well as 123 healthy controls.

They detected tissue IgA–antitransglutaminase-2 antibodies, a key serologic

marker of celiac disease, in 7 MS patients (10%) but in only 3 controls

(2.4%), a statistically significant difference (*P* < .05; odds ratio, 5.33;

95% confidence interval, 1.074 – 26.425).

They also detected mild or moderate villous atrophy (Marsh III type) in

duodenal biopsy specimens from 8 MS patients (11.1%). There were no

significant differences between MS and control patients in HLA-DQ2 and

HLA-DQ8 genetic susceptibility markers of celiac disease.

In addition, 23 of 126 first-degree relatives of MS patients had celiac

disease (32%).

The only differential parameter between MS patients with celiac disease and

those without was the age at onset of MS, which was younger (35 ± 7 years

old) in the former and older (44 ± 10 years old) in the latter (*P* < .05).

All of the 8 MS patients with celiac disease were female.

*Early Detection, Treatment Key*

On the basis of their initial experience, the clinicians say they put all of

the MS patients with celiac disease on a gluten-free diet " and all of them

improved considerably both with respect to the gastrointestinal and to the

neurological symptomatology in the follow-up period, " they report.

" So the main message that we want to [get out] to doctors who attend MS

patients is to perform clinical, serological, genetic, and histologic

studies directed to find a possible associated [celiac disease], " Dr.

Rodrigo told *Medscape Medical News*. " All these studies must be done in

collaboration with a gastroenterologist expert in this field, " he noted.

L. Gross, MD, from Associated Neurologists of Southern Connecticut

in Fairfield, who was not involved in the study, said he too has had

experience with a patient whose MS symptoms improved after their celiac

disease was brought under control.

In a telephone interview with *Medscape Medical News*, he made the point

that it is " sometimes difficult to say whether a person with celiac disease

is having neurological symptoms on the basis of their celiac or whether it's

just 2 conditions occurring simultaneously in the same individual. "

He noted, however, that there is " a statistical link between Crohn's disease

and MS and 1 of the 9 drugs now approved for MS is also approved for Crohn's

disease, so there is a link between the gut and the brain somehow. "

*The study authors and Dr. Gross have disclosed no relevant financial

relationships*.

*BMC Neurol*. 2011;11:31. Published online March 7, 2011.

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

Check out my blog: mixture of deals and nutrition

New Giveaway : Healthy Toys from The Frugal Dietitian Ends on 3/16 8

PM<http://thefrugaldietitian.com/?p=16384>Mini-Social:

Mom and Kids daily deal site <http://thefrugaldietitian.com/?p=16288> Made

my own " funny but real " movie: Me interviewing a " potential " Dietetic

student <

*Healthy Diet at any Age: We are NOT just looking

*

*at the years people have behind them but also the

*

*quality of the years ahead of them.*