Celiac Disease, Beyond the Bowel: A Review of Its Neurological Manifestations.

Saawan C Patel, Devarashetty Shreya, Diana I Zamora, Gautami S Patel, Idan Grossmann, Kevin Rodriguez, Mridul Soni, Pranay K Joshi, Ibrahim Sange

Journal: Cureus 2021;13(12):e20112

PMID: 34984152

Plain Language Summary

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Coeliac disease (CD) is an autoimmune condition in which genetically predisposed individuals develop an immunologic reaction to ingested gluten, a protein found in barley, wheat, and rye, destroying the intestinal villi. The aims of this review are to: (i) underline the pathogenic mechanism of the involvement of CD and its neurological manifestations; (ii) establish a clinical relationship between CD and its neurological manifestations; (iii) explore the existing screening and upcoming management guidelines of CD. This review shows that: - the most common neurological manifestations of CD include gluten ataxia, gluten neuropathy, and epilepsy. These conditions are strongly associated with a lower quality of life and a higher rate of hospitalisation. - neurological features of CD should be kept in mind in order to raise an adequate amount of clinical suspicion to perform screening for gluten sensitivity with the aim of reducing the time it takes for diagnosis, and thus patient suffering is kept to a minimum. Authors conclude that further thorough studies about neurological manifestations of CD are needed so that alternative treatment modalities are offered to provide a more holistic treatment approach to a patient with CD.

Abstract

Celiac disease (CD) is a multi-systemic autoimmune condition that causes a hyperinflammatory response when gluten is ingested. There has been a shift in the clinical presentation of CD from a mere malabsorption disorder to an autoimmune condition that affects multiple organ systems, which could increase the rate of hospitalizations and a decreased quality of life. This article has compiled various studies that have explored the neurological manifestations of celiac disease, their epidemiology, possible pathogenic mechanisms, diagnosis, and treatment. The most common neurological conditions include gluten ataxia (GA), gluten neuropathy, gluten encephalopathy, and epilepsy which usually present as sporadic diseases which are difficult to diagnose in the absence of gastrointestinal (GI) symptoms. The treatment for most of these conditions is a gluten-free diet (GFD) regardless of GI involvement.

Copyright © 2021, Patel et al.

Address: Internal Medicine, Pramukhswami Medical College, Karamsad, IND.; Internal Medicine, Gandhi Medical College, Secunderabad, Hyderabad, IND.; General Medicine, Universidad de Ciencias Médicas Andrés Vesalio Guzman, San José, CRI.; Research, Medical University of Silesia in Katowice Faculty of Medical Sciences, Katowice, POL.; Research, Universidad Americana (UAM) Facultad de Medicina, Managua, NIC.; Research, Shri Lal Bahadur Shastri Government Medical College, Mandi, IND.; Department of Medicine, Byramjee Jeejabhoy Medical College, Ahmedabad, IND.; Research, Karamshi Jethabhai Somaiya Medical College, Mumbai, IND.

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