Neurology and Celiac Disease..FROM GUT TO BRAIN

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FROM GUT TO BRAIN

Gluten sensitivity is best defined as a state of heightened immunological

responsiveness in genetically susceptible people.15 This definition does not

imply bowel involvement. That gluten sensitivity is regarded as principally a

disease of the small bowel is a historical misconception.28 Gluten sensitivity

can be primarily and at times exclusively a neurological disease.29 The absence

of an enteropathy should not preclude patients from treatment with a gluten-free

diet. Early diagnosis and removal of the trigger factor by the introduction of

gluten-free diet is a promising therapeutic intervention. IgG antigliadin

antibodies should be part of the routine investigation of all patients with

neurological dysfunction of obscure aetiology, particularly patients with ataxia

and peripheral neuropathy.

What do I do with a patient with positive anti-gliadin antibody test but normal

duodenal biopsy "

Only one third of the patients with neurological disorders associated with

gluten sensitivity have villous atrophy on duodenal biopsy. Even some with

biochemical markers of malabsorption such as low serum vitamin B12, low red cell

folate, or vitamin D concentrations had normal conventional duodenal

histology.17 These cases may illustrate the patchy nature of bowel involvement

in coeliac disease and the inaccurate interpretation of duodenal biopsies by

inexperienced histopathologists. Preliminary data based on staining of the

subpopulation of T cells in the small bowel epithelium suggests that these

patients have potential CD.24 There are, however, patients where the

immunological disorder is primarily directed at the nervous system with little

or no damage to the gut. Our practice is to offer a gluten-free diet to these

patients unless the HLA genotype is not consistent with susceptibility to gluten

intolerance (that is, other than HLA DQ2, DQ8, or DQ1). All patients are

followed up and any clinical response is documented.

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Shortcut to: http://jnnp.bmjjournals.com/cgi/content/full/72/5/560

Neurology and Celiac Disease

Celiac Disease and Peripheral Neuropathy, Norman Latov, MD, PHD

Is the prevalence of celiac disease increased among epileptic patients? Pratesi,

et al

Neurologic Presentation of Celiac Disease, Bushara 2005 April

Neurological manifestations of coeliac disease by Liisa Luostarinen

Neurological complications of coeliac disease, D.S.N.A Pengiran Tengah, A.J.

Wills, G.T.K. Holmes (2002)

Gluten Sensitivity

Gluten sensitivity as a neurological illness, M Hadjivassiliou, et al.

" Early Diagnosis Of Gluten Sensitivity: Before the Villi Are Gone " by

Fine, MD

Diagnosis of Gluten Sensitivity in the 21st Century by Fine, M. D.

Gluten intolerance: a paradigm of an epidemic by Astor Shaul

Gluten sensitivity: a many headed hydra, M Hadjivassiliou, et al.

Gluten sensitivity: time to move from gut to brain, M Hadjivassiliou

Neuromuscular disorder as a presenting feature of celiac disease, M

Hadjivassiliou, et al.

Sporadic cerebellar ataxia associated with gluten sensitivity

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Last edited by jcc : 05-16-2006 at 09:01 AM.

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