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Emami MH, Najafi MR, Allahdadian S, Mohammadzadeh S, Jamali N, Lalazarian A, Shaygan Nejad V, Maghool F. Evaluation of the Prevalence of Anti-transglutaminase 2 and 6 Antibodies in Patients with Sero-Positive Multiple Sclerosis. Middle East J Dig Dis 2024; 16:47-51. [PMID: 39050097 PMCID: PMC11264836 DOI: 10.34172/mejdd.2024.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/17/2023] [Indexed: 07/27/2024] Open
Abstract
Background Gluten sensitivity (GS) is one of the gluten-related disorders (GRDs). Patients with GS may have serum antibodies against tissue transglutaminase (tTG) (IgA and IgG) without any evidence of enteropathy. We aimed to evaluate both tTG-6 and tTG-2 antibodies to determine the prevalence of seropositive tTG-2 and tTG-6 antibodies in patients with multiple sclerosis (MS). Methods In this cross-sectional study, we carried out serological tests (IgA & IgG anti-tTG-6 and tTG-2 antibodies) in patients with MS. Results Seventy-two patients with MS were included in this study. Of them, seropositive patients for total (IgA+IgG) of tTG-6 and tTG-2 autoantibodies were 9.7% (95% CI, 4.2-18) and 5.6% (95% CI, 1.4-12.5), respectively. Conclusion Anti-tTG-6 antibody testing may be necessary for early diagnosis of GS in patients with MS. More studies with larger sample sizes are warranted to confirm these data.
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Affiliation(s)
- Mohammad Hassan Emami
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Pooya Zist-Mabna Hakim Company, Poursina Hakim Institute, Isfahan, Iran
| | - Mohammad Reza Najafi
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Centre (INRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sepideh Allahdadian
- Department of Neurology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Samane Mohammadzadeh
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Pooya Zist-Mabna Hakim Company, Poursina Hakim Institute, Isfahan, Iran
| | - Nahid Jamali
- Department of Health Policy, School of Management and Information, Iran University of Medical Sciences, Tehran
- Iranian Celiac Association, Isfahan, Iran
| | - Anasik Lalazarian
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Pooya Zist-Mabna Hakim Company, Poursina Hakim Institute, Isfahan, Iran
| | - Vahid Shaygan Nejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Centre (INRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Maghool
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Pooya Zist-Mabna Hakim Company, Poursina Hakim Institute, Isfahan, Iran
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A Prospective Study on Cognitive Impairment in Middle-aged Adults With Newly Diagnosed Celiac Disease. J Clin Gastroenterol 2019; 53:290-294. [PMID: 29498953 DOI: 10.1097/mcg.0000000000001018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS Our objectives were to: (1) determine whether celiac disease (CD) patients have cognitive impairment at diagnosis; and (2) compare their cognitive performance with nonceliac subjects who have similar chronic symptoms and healthy controls. MATERIALS AND METHODS Fifty adults (age range: 18 to 50 y) with symptoms and signs compatible with CD were enrolled in a prospective cohort irrespective of the final diagnosis. At baseline, all individuals underwent cognitive functional and psychological evaluation. CD patients were compared with subjects in whom CD was ruled out and with healthy controls matched by sex, age, and years of schooling. RESULTS Thirty-three subjects (66%) were diagnosed with CD. Compared with the healthy controls (n=26), CD cases and disease controls (n=17; mostly irritable bowel syndrome) had impaired cognitive performance (P=0.02 and P=0.04, respectively), functional impairment (P<0.01), and higher depression (P<0.01). CD patients had similar cognitive performance and anxiety, but nonsignificant lower depression scores compared with disease controls. CONCLUSIONS Abnormal cognitive functions detected in newly diagnosed CD adult patients seem not to be disease specific. Our results suggest that cognitive dysfunction could be related to the presence of prolonged symptoms due to a chronic disease.
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Mearns ES, Taylor A, Thomas Craig KJ, Puglielli S, Cichewicz AB, Leffler DA, Sanders DS, Lebwohl B, Hadjivassiliou M. Neurological Manifestations of Neuropathy and Ataxia in Celiac Disease: A Systematic Review. Nutrients 2019; 11:E380. [PMID: 30759885 PMCID: PMC6412791 DOI: 10.3390/nu11020380] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022] Open
Abstract
Celiac disease (CD) is an immune-mediated gastrointestinal disorder driven by innate and adaptive immune responses to gluten. Patients with CD are at an increased risk of several neurological manifestations, frequently peripheral neuropathy and gluten ataxia. A systematic literature review of the most commonly reported neurological manifestations (neuropathy and ataxia) associated with CD was performed. MEDLINE, Embase, the Cochrane Library, and conference proceedings were systematically searched from January 2007 through September 2018. Included studies evaluated patients with CD with at least one neurological manifestation of interest and reported prevalence, and/or incidence, and/or clinical outcomes. Sixteen studies were included describing the risk of gluten neuropathy and/or gluten ataxia in patients with CD. Gluten neuropathy was a neurological manifestation in CD (up to 39%) in 13 studies. Nine studies reported a lower risk and/or prevalence of gluten ataxia with a range of 0%⁻6%. Adherence to a gluten-free diet appeared to improve symptoms of both neuropathy and ataxia. The prevalence of gluten neuropathy and gluten ataxia in patients with CD varied in reported studies, but the increased risk supports the need for physicians to consider CD in patients with ataxia and neurological manifestations of unknown etiology.
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Affiliation(s)
| | - Aliki Taylor
- Takeda Development Centre Europe Ltd., London WC2B 4AE, UK;
| | | | | | | | | | - David S. Sanders
- Royal Hallamshire Hospital and University of Sheffield, Sheffield S10 2RX, UK; (D.S.S.); (M.H.)
| | - Benjamin Lebwohl
- Department of Medicine, Celiac Disease Center, Columbia University Medical Center, New York, NY 10032, USA;
| | - Marios Hadjivassiliou
- Royal Hallamshire Hospital and University of Sheffield, Sheffield S10 2RX, UK; (D.S.S.); (M.H.)
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4
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Lin CY, Wang MJ, Tse W, Pinotti R, Alaedini A, Green PHR, Kuo SH. Serum antigliadin antibodies in cerebellar ataxias: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2018; 89:1174-1180. [PMID: 29866704 PMCID: PMC6231948 DOI: 10.1136/jnnp-2018-318215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gluten sensitivity refers to prominent immunological responses to gluten, usually in conjunction with elevated levels of serum antigliadin antibody (AGA). The association between AGA and cerebellar ataxias has been inconsistently reported. METHODS We performed a systematic literature search and a meta-analysis to study the weighted pooled OR of idiopathic cerebellar ataxia (IDCA) cases to controls or to hereditary ataxia (HA) for AGA seropositivity using fixed effect model. RESULTS Eleven studies were included, with a total of 847 IDCA cases, 1654 controls and 445 HA cases. IDCA cases had fourfold higher odds than controls (OR 4.28, 95% CI 3.10 to 5.90) and twofold higher odds than HA cases (OR 2.23, 95% CI 1.45 to 3.44) of having AGA seropositivity. Sensitivity analysis excluding the most weighted study, which accounted for 69% of the total weight, still showed similar associations (IDCA vs controls, OR 3.18, 95% CI 1.79 to 5.67 and IDCA vs HA, OR 1.72, 95% CI 1.03 to 2.86, respectively). The subgroup analysis showed that, when compared with controls, IDCA cases of both East Asian and Western countries had approximately threefold to fourfold higher odds to have AGA seropositivity (OR 3.41, 95% CI 1.67 to 6.97 and OR 4.53, 95% CI 3.16 to 6.49, respectively), suggesting the lack of ethnic heterogeneity. The odds of AGA seropositivity for HA cases was not significantly higher than controls (OR 1.41, 95% CI 0.82 to 2.44). CONCLUSION Our study indicates the association between AGA and IDCA, across different geographic regions.
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Affiliation(s)
- Chi-Ying Lin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Min-Jung Wang
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Winona Tse
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Rachel Pinotti
- Levy Library, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Armin Alaedini
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Peter H R Green
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York, USA
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York, USA
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5
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Collin P, Vilppula A, Luostarinen L, Holmes GKT, Kaukinen K. Review article: coeliac disease in later life must not be missed. Aliment Pharmacol Ther 2018; 47:563-572. [PMID: 29322540 DOI: 10.1111/apt.14490] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 08/17/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The presenting symptoms of coeliac disease are often subtle and the diagnosis is frequently delayed or overlooked. Therefore, especially elderly patients may be denied the benefits conferred by gluten free diet which can be dramatically life-changing. AIM To review the occurrence, clinical features, diagnosis and management in coeliac patients detected later in life. METHODS To review manuscripts concerned with coeliac disease in the elderly and to derive subgroups of elderly people from publications on the disorder. RESULTS Approximately a quarter of all diagnoses are now made at the age of 60 years or more and a fifth at 65 years or over. About 4% are diagnosed at 80 years or above. Around 60% remain undetected, since their symptoms are often subtle: tiredness, indigestion, reduced appetite. Good compliance with gluten free diet, resolution of symptoms and improvement in laboratory indices can be achieved in over 90% of patients. CONCLUSIONS Coeliac disease not uncommonly presents for the first time in older patients and is an important diagnosis to make.
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Affiliation(s)
- P Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,University of Tampere, Tampere, Finland
| | - A Vilppula
- Department of Clinical Neurophysiology, Neuroscience, HUS Medical Imaging Centre, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | | | - G K T Holmes
- Department of Gastroenterology, the Royal Derby Hospital, Derby, UK
| | - K Kaukinen
- Department of Medicine, Faculty of Medicine and Life-Sciences, Tampere University Hospital, University of Tampere, Tampere, Finland
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6
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Brietzke E, Cerqueira RO, Mansur RB, McIntyre RS. Gluten related illnesses and severe mental disorders: a comprehensive review. Neurosci Biobehav Rev 2017; 84:368-375. [PMID: 28830676 DOI: 10.1016/j.neubiorev.2017.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022]
Abstract
The putative role of gluten in the pathophysiology of severe mental illnesses remains uncertain and there is doubt about the possible benefit of gluten-free diets for individuals affected by psychosis and mood disorders. The objective of this review was to summarize the findings linking gluten related conditions to pathophysiological substrates implicated in schizophrenia and mood disorders and review the evidences of potential benefits of glute-free diets in these populations. A literature search was conducted within PubMed and Scielo databases including references from inception until March 1st 2017. The strategy search was to use the key words "gluten", "celiac disease", "wheat", "bipolar disorder", "mood disorders", "psychosis", "schizophrenia", "depression". In the review about the potential efficacy of gluten-free diets in severe mental illnesses, we included only studies with original data, including cross sectional and longitudinal studies and clinical trials. Book chapters, review articles and meta-analysis and republished data were excluded. Although the current available evidences suggest that people with celiac disease or gluten allergy could have a slightly higher risk of schizophrenia and mood disorders compared to the general population, the literature review reveals significant inaccuracies in the data. There is insufficient evidence to recommend gluten-free diets for populations with psychosis and mood disorders.
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Affiliation(s)
- Elisa Brietzke
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Federal University of São Paulo (Unifesp), São Paulo, Brazil; Mood Disorders Psychpharmachology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Canada.
| | - Raphael O Cerqueira
- Research Group in Molecular and Behavioral Neuroscience of Bipolar Disorder, Federal University of São Paulo (Unifesp), São Paulo, Brazil
| | - Rodrigo B Mansur
- Mood Disorders Psychpharmachology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychpharmachology Unit (MDPU), Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Canada; Brain and Cognition Discovery Foundation, Toronto, Canada
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7
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Abstract
There is a growing interest in the extraintestinal manifestations of common pediatric gastrointestinal diseases, such as inflammatory bowel disease and celiac disease. This article specifically focuses on the neurological symptoms that manifest because of these disorders and their treatments. Many neurological symptoms have been reported in association with these diseases, including neuropathy, myopathy, ataxia, headache, and seizures, among others. It is currently believed that these neurological symptoms are largely overlooked by practitioners and could be a red flag for earlier diagnosis. However, additional research, especially in the pediatric population, is warranted to further elaborate on the causality and pathophysiology of these neurological symptoms.
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Affiliation(s)
- Melissa Shapiro
- From the Section of Gastroenterology, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA
| | - David A Blanco
- From the Section of Gastroenterology, Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
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8
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Rodrigo L, Hernández-Lahoz C, Lauret E, Rodriguez-Peláez M, Soucek M, Ciccocioppo R, Kruzliak P. Gluten ataxia is better classified as non-celiac gluten sensitivity than as celiac disease: a comparative clinical study. Immunol Res 2016; 64:558-64. [PMID: 26676361 DOI: 10.1007/s12026-015-8750-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gluten ataxia (GA) has customarily been considered to be the main neurological manifestation of celiac disease (CD). In recent years, the condition of non-celiac gluten sensitivity (NCGS) has been defined, which includes some patients who are not considered "true celiacs." We performed a comparative clinicopathological study of these three entities. We studied 31 GA, 48 CD and 37 NCGS patients, prospectively in the same center for a period of 7 years. The protocol study included two serological determinations for gluten sensitivity [anti-gliadin IgA and IgG (AGA) and anti-tissue transglutaminase IgA (TG) antibodies], HLA-DQ2 typing, and duodenal histological assessment. Demographics and investigative findings were compared. Females were 55 % in GA, 75 % in CD (p < 0.001), and 47 % in NCGS (N.S.). GA patients were older (59 ± 14 years) than CD (43 ± 13 years) and NCGS (41 ± 8 years) groups (p < 0.001). AGA positivity was higher in GA (100 %) than in CD (48 %) groups (p < 0.001), but similar to NCGS patients (89 %; N.S.); TG positivity was lower in GA (3.2 %) than in CD (33.3 %; p < 0.001), but similar to NCGS (2.7 %; N.S.). DQ2 (+) was lower in GA (32.2 %) than in CD (89.6 %; p < 0.001), but similar to NCGS (29.7 %; N.S.). Lymphocytic enteritis (Marsh type 1) was lower in GA (9.6 %) than in CD (66.7 %; p < 0.001), but similar to NCGS (10.8 %; N.S.). The other gluten sensitivity-related characteristics measured were different to CD patients, but very close to NCGS. We conclude that GA patients are better classified within the NCGS group, than within CD.
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Affiliation(s)
- Luis Rodrigo
- Gastroenterology Unit, Central University Hospital of Asturias (HUCA), Oviedo, Spain.
- School of Medicine, University of Oviedo, Julian Clavería s no., 33006, Oviedo, Spain.
| | | | - Eugenia Lauret
- Gastroenterology Unit, Central University Hospital of Asturias (HUCA), Oviedo, Spain
| | | | - Miroslav Soucek
- 2nd Department of Internal Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Rachele Ciccocioppo
- Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Peter Kruzliak
- 2nd Department of Internal Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University, Odborarov 10, 832 32, Bratislava, Slovak Republic.
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9
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Abstract
The term gluten-related disorders (GRD) refers to a spectrum of diverse clinical manifestations triggered by the ingestion of gluten in genetically susceptible individuals. They include both intestinal and extraintestinal manifestations. Gluten ataxia (GA) is one of the commonest neurological manifestations of GRD. It was originally defined as otherwise idiopathic sporadic ataxia in the presence of circulating antigliadin antibodies of IgA and/or IgG type. Newer more specific serological markers have been identified but are not as yet readily available. GA has a prevalence of 15% amongst all ataxias and 40% of all idiopathic sporadic ataxias. It usually presents with gait and lower limb ataxia. It is of insidious onset with a mean age at onset of 53 years. Up to 40% of patients have evidence of enteropathy on duodenal biopsy. Gastrointestinal symptoms are seldom prominent and are not a reliable indicator for the presence of enteropathy. Furthermore, the presence of enteropathy does not influence the response to a gluten-free diet. Most patients will stabilise or improve with strict adherence to gluten-free diet depending on the duration of the ataxia prior to the treatment. Up to 60% of patients with GA have evidence of cerebellar atrophy on MR imaging, but all patients have spectroscopic abnormalities primarily affecting the vermis. Recent evidence suggests that patients with newly diagnosed coeliac disease presenting to the gastroenterologists have abnormal MR spectroscopy at presentation associated with clinical evidence of subtle cerebellar dysfunction. The advantage of early diagnosis and treatment (mean age 42 years in patients presenting with gastrointestinal symptoms vs. 53 years in patients presenting with ataxia) may protect the first group from the development and/or progression of neurological dysfunction.
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10
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Jackson J, Eaton W, Cascella N, Fasano A, Santora D, Sullivan K, Feldman S, Raley H, McMahon RP, Carpenter WT, Demyanovich H, Kelly DL. Gluten sensitivity and relationship to psychiatric symptoms in people with schizophrenia. Schizophr Res 2014; 159:539-42. [PMID: 25311778 PMCID: PMC4476307 DOI: 10.1016/j.schres.2014.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/09/2014] [Accepted: 09/11/2014] [Indexed: 12/20/2022]
Abstract
The relationship between gluten sensitivity and schizophrenia has been of increasing interest and novel mechanisms explaining this relationship continue to be described. Our study in 100 people with schizophrenia compared to 100 matched controls replicates a higher prevalence of gluten sensitivity and higher mean antigliadin IgG antibody levels schizophrenia (2.9 ± 7.7 vs. 1.3 ± 1.3, p = 0.046, controlled for age). Additionally, we examined symptoms within the schizophrenia group and found that while positive symptoms are significantly lower in people who have elevated antigliadin antibodies (AGA; 4.11 ± 1.36 vs. 6.39 ± 2.99, p = 0.020), no robust clinical profile differentiates between positive and negative antibody groups. Thus, identifying people in schizophrenia who may benefit from a gluten-free diet remains possible by blood test only.
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Affiliation(s)
- Jessica Jackson
- Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - William Eaton
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
| | - Nicola Cascella
- Neuropsychiatry Program Sheppard Pratt Hospital, 6501 North Charles Street, Baltimore, MD 21285, USA
| | - Alessio Fasano
- Massachusetts General Hospital for Children, 175 Cambridge Street, Boston, MA 02114, USA; Massachusetts General Hospital East, 16th Street, Charlestown, MA 02129, USA
| | - Debby Santora
- University of Maryland School of Medicine, 660 West Redwood Street, Baltimore, MD 21201, USA
| | - Kelli Sullivan
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Stephanie Feldman
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Heather Raley
- National Institute on Drug Abuse, 251 Bayview Blvd., Baltimore, MD 21223, USA
| | - Robert P McMahon
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - William T Carpenter
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Haley Demyanovich
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA
| | - Deanna L Kelly
- University of Maryland School of Medicine, Department of Psychiatry, Maryland Psychiatric Research Center, 55 Wade Avenue, Catonsville, MD 21228, USA.
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Hadjivassiliou M, Duker AP, Sanders DS. Gluten-related neurologic dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2014; 120:607-19. [PMID: 24365341 DOI: 10.1016/b978-0-7020-4087-0.00041-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The term gluten-related disorders (GRD) encompasses a spectrum of systemic autoimmune diseases with diverse manifestations. GRD are characterized by abnormal immunological responsiveness to ingested gluten in genetically susceptible individuals. Celiac disease (CD) or gluten-sensitive enteropathy is only one of a number of GRD. Extraintestinal manifestations include dermatitis herpetiformis (DH) and neurologic dysfunction. Furthermore it is only recently that the concept of extraintestinal manifestations without enteropathy has become accepted. In this chapter we review the spectrum of neurologic manifestations in GRD, discuss recent advances in their diagnosis, and look at their possible pathophysiologic mechanisms.
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Affiliation(s)
| | - Andrew P Duker
- Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - David S Sanders
- Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
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12
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Abstract
Neurologic complications of celiac disease (CD) include ataxia and peripheral neuropathy, which can be the presenting symptoms and signs. Early diagnosis and intervention could prevent development of further neurologic and systemic complications. Questions remain regarding the prevalence of the neurologic complications, the pathophysiological mechanisms, and the effectiveness of therapy or response to a gluten-free diet.
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13
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Sapone A, Bai JC, Ciacci C, Dolinsek J, Green PHR, Hadjivassiliou M, Kaukinen K, Rostami K, Sanders DS, Schumann M, Ullrich R, Villalta D, Volta U, Catassi C, Fasano A. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med 2012; 10:13. [PMID: 22313950 PMCID: PMC3292448 DOI: 10.1186/1741-7015-10-13] [Citation(s) in RCA: 635] [Impact Index Per Article: 52.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 02/07/2012] [Indexed: 02/08/2023] Open
Abstract
A decade ago celiac disease was considered extremely rare outside Europe and, therefore, was almost completely ignored by health care professionals. In only 10 years, key milestones have moved celiac disease from obscurity into the popular spotlight worldwide. Now we are observing another interesting phenomenon that is generating great confusion among health care professionals. The number of individuals embracing a gluten-free diet (GFD) appears much higher than the projected number of celiac disease patients, fueling a global market of gluten-free products approaching $2.5 billion (US) in global sales in 2010. This trend is supported by the notion that, along with celiac disease, other conditions related to the ingestion of gluten have emerged as health care concerns. This review will summarize our current knowledge about the three main forms of gluten reactions: allergic (wheat allergy), autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia) and possibly immune-mediated (gluten sensitivity), and also outline pathogenic, clinical and epidemiological differences and propose new nomenclature and classifications.
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Affiliation(s)
- Anna Sapone
- Mucosal Biology Research Center and Center for Celiac Research, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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14
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Abstract
The cerebellum, and in particular the Purkinje cells within it, appear to be a frequent immunological target in the context of some systemic diseases. This is perhaps more often the case with the cerebellum by comparison to other structures within the central nervous system. This observation may relate to the fact that the cerebellum is one of the largest, oldest, and most structurally conserved structures in the vertebrate nervous system and/or that Purkinje cells possess good and multiple antigenic targets. Immune-mediated ataxias include paraneoplastic cerebellar degeneration and post-infective cerebellitis, but these will be discussed elsewhere. This chapter covers in detail the epidemiology, clinical characteristics, pathophysiology, and treatment of some other examples of immune-mediated ataxias, including gluten ataxia and ataxia associated with anti-GAD antibodies. There is particular emphasis on gluten ataxia as this is one of the commonest immune-mediated cerebellar ataxias and one of the few ataxias that are potentially treatable. The chapter also introduces the concept of primary autoimmune cerebellar ataxia as a form of organ-specific autoimmune disease for the first time. The pathophysiology leading to cerebellar damage, loss of Purkinje cells, and the development of ataxia remains speculative, but existing clues are discussed in detail.
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15
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[Clinical manifestations of adult celiac disease]. ACTA ACUST UNITED AC 2011; 61:e47-51. [PMID: 21621928 DOI: 10.1016/j.patbio.2011.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 03/23/2011] [Indexed: 11/21/2022]
Abstract
Celiac disease is an enteropathy due to gluten intake in genetically predisposed persons (HLA DQ2/DQ8). Celiac disease occurs in adults and children at rates approaching 1% of population in Europe and USA. Celiac disease is extremely various and anaemia, oral aphthous stomatis, amenorrhea or articular symptoms may be the only revealing symptoms. Diagnosis releases on evidence of histological villous atrophy in proximal small bowel and presence of specific serum antibodies. Treatment relies on eviction of gluten. Gluten free diet allows prevention of malignant complications such as small bowel adenocarcinoma and lymphoma and osteopenia. The main cause of resistance to gluten free diet is its bad observance. On the contrary, serious complications of celiac disease, such as clonal refractory celiac sprue and intestinal T-cell lymphoma need to be screen.
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Malamut G, Cellier C. [Celiac disease]. Rev Med Interne 2010; 31:428-33. [PMID: 20359791 DOI: 10.1016/j.revmed.2009.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 03/13/2009] [Accepted: 04/05/2009] [Indexed: 01/01/2023]
Abstract
Celiac disease is an enteropathy due to gluten intake in genetically predisposed individuals (HLA DQ2/DQ8). Celiac disease occurs in adults and children at rates approaching 1% of population in Europe and USA. Clinical features observed in celiac disease are extremely various and anaemia, oral aphthous stomatis, amenorrhea or articular symptoms may be the only presenting manifestations. Diagnosis relies on the evidence of histological villous atrophy in proximal small bowel and the presence of specific serum antibodies. Treatment relies on eviction of gluten (wheat, barley, rye) from diet. Gluten free diet allows prevention of malignant complications such as small bowel adenocarcinoma and lymphoma, and osteopenia. The main cause of resistance to gluten free diet is its poor observance. If not the case, serious complications of celiac disease, such as clonal refractory celiac sprue and intestinal T-cell lymphoma should be suspected. Current therapeutic challenges concern alternative to gluten free diet and new efficient treatments of lymphomatous complications.
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Affiliation(s)
- G Malamut
- Université Paris Descartes, 75006 Paris, France.
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Abstract
In recent years, there has been increasing recognition of the presence of gastrointestinal (GI) dysfunction in the setting of neurologic diseases. Parkinson's disease is a particularly well-known example, but GI dysfunction also may occur in multiple sclerosis, stroke, and in various myopathic and peripheral neuropathic processes. There is much less awareness, however, that primary GI diseases may also display neurologic dysfunction as part of their clinical picture. This article focuses on some of those disease processes. Illnesses primarily targeting the GI tract are addressed and examples of primary esophageal, gastric, and intestinal disease processes are described.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, University of Tennessee Health Science Center, 855 Monroe Avenue, Memphis, TN 38163, USA.
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Malamut G, Meresse B, Cellier C, Cerf-Bensussan N. La maladie cœliaque en 2009 : un futur sans régime ? ACTA ACUST UNITED AC 2009; 33:635-47. [DOI: 10.1016/j.gcb.2009.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hadjivassiliou M, Sanders DS, Woodroofe N, Williamson C, Grünewald RA. Gluten ataxia. THE CEREBELLUM 2008; 7:494-8. [DOI: 10.1007/s12311-008-0052-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Celiac disease (CD) or gluten sensitive enteropathy is relatively common in western populations with prevalence around 1%. With the recent availability of sensitive and specific serological testing, many patients who are either asymptomatic or have subtle symptoms can be shown to have CD. Patients with CD have modest increases in risks of malignancy and mortality compared to controls. The mortality among CD patients who comply poorly with a gluten-free diet is greater than in compliant patients. The pattern of presentation of CD has altered over the past three decades. Many cases are now detected in adulthood during investigation of problems as diverse as anemia, osteoporosis, autoimmune disorders, unexplained neurological syndromes, infertility and chronic hypertransaminasemia of uncertain cause. Among autoimmune disorders, increased prevalence of CD has been found in patients with autoimmune thyroid disease, type 1 diabetes mellitus, autoimmune liver diseases and inflammatory bowel disease. Prevalence of CD was noted to be 1% to 19% in patients with type 1 diabetes mellitus, 2% to 5% in autoimmune thyroid disorders and 3% to 7% in primary biliary cirrhosis in prospective studies. Conversely, there is also an increased prevalence of immune based disorders among patients with CD. The pathogenesis of co-existent autoimmune thyroid disease and CD is not known, but these conditions share similar HLA haplotypes and are associated with the gene encoding cytotoxic T-lymphocyte-associated antigen-4. Screening high risk patients for CD, such as those with autoimmune diseases, is a reasonable strategy given the increased prevalence. Treatment of CD with a gluten-free diet should reduce the recognized complications of this disease and provide benefits in both general health and perhaps life expectancy. It also improves glycemic control in patients with type 1 diabetes mellitus and enhances the absorption of medications for associated hypothyroidism and osteoporosis. It probably does not change the natural history of associated autoimmune disorders.
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Affiliation(s)
- Chin Lye Ch'ng
- Department of Gastroenterology, Singleton Hospital, Swansea, United Kingdom
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Boscolo S, Sarich A, Lorenzon A, Passoni M, Rui V, Stebel M, Sblattero D, Marzari R, Hadjivassiliou M, Tongiorgi E. Gluten ataxia: passive transfer in a mouse model. Ann N Y Acad Sci 2007; 1107:319-28. [PMID: 17804560 DOI: 10.1196/annals.1381.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Gluten sensitivity is an autoimmune disease that usually causes intestinal atrophy resulting in a malabsorption syndrome known as celiac disease. However, gluten sensitivity may involve several organs and is often associated with extraintestinal manifestations. Typically, patients with celiac disease have circulating anti-tissue transglutaminase and anti-gliadin antibodies. When patients with gluten sensitivity are affected by other autoimmune diseases, other autoantibodies may arise like anti-epidermal transglutaminase in dermatitis herpetiformis, anti-thyroid peroxidase antibodies in thyroiditis, and anti-islet cells antibodies in type 1 diabetes. The most common neurological manifestation of gluten sensitivity is ataxia, the so-called gluten ataxia (GA). In patients with GA we have demonstrated that anti-gliadin and anti-tissue transglutaminase antibodies cross-react with neurons but that additional anti-neural antibodies are present. The aim of the present article is to review the knowledge on animal models of gluten sensitivity, as well as reviewing the role of anti-neural antibodies in GA.
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Affiliation(s)
- Sabrina Boscolo
- BRAIN Centre for Neuroscience, Department of Biology, University of Trieste, Via Giorgieri 10, 34127 Trieste, Italy.
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Pfeiffer RF. NEUROLOGICAL DYSFUNCTION IN GASTROINTESTINAL DISEASES. Continuum (Minneap Minn) 2005. [DOI: 10.1212/01.con.0000293720.86238.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hadjivassiliou M, Williamson CA, Woodroofe N. The immunology of gluten sensitivity: beyond the gut. Trends Immunol 2004; 25:578-82. [PMID: 15489185 DOI: 10.1016/j.it.2004.08.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Marios Hadjivassiliou
- Department of Neurology, The Royal Hallamshire Hospital, Glossop Road, Sheffield, UK, S10 2JF.
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Malamut G, Cellier C. Maladie cœliaque : dépistage de masse ou diagnostic dans des populations ciblées ? ACTA ACUST UNITED AC 2004; 28:863-7. [PMID: 15523222 DOI: 10.1016/s0399-8320(04)95149-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Georgia Malamut
- Service d'Hépato-gastroentérologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris
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Abstract
Celiac disease remains a challenge to the clinician and scientist. It is clearly more prevalent than was previously suspected. Much interest is seen in identifying the genetic factors, which predispose to disease and the environmental agents that can trigger it. Genome-wide searches have identified a number of chromosomal susceptibility loci. Specific gliadin epitopes are being analyzed. New diagnostic options include the tissue transglutaminase enzyme-linked immunosorbent assay. Neurologic disease and bone disease are intriguing complications of celiac disease and are gradually being defined.
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Affiliation(s)
- Jason S R Jennings
- Academic Unit of General Surgery, Medicine, and Anaesthesia, St. James's University Hospital, Leeds, United Kingdom.
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Abstract
Coeliac disease is the prototypical gluten-sensitive disease. Clinico-pathological features heal on a gluten-free diet and relapse when gluten is reintroduced. An immunopathology is suspected. A number of neurological syndromes may be associated with coeliac disease but it is unclear whether these are directly or indirectly caused by gluten ingestion. It has been proposed that idiopathic ataxias and central nervous system white matter disease are gluten-sensitive syndromes. This is an exciting hypothesis because it offers new therapeutic possibilities including simple exclusion diets. However, interpretation is difficult because occult sub-clinical coeliac disease occurs commonly and background prevalence needs to be accounted for in population-based studies. This review will attempt to summarize the pertinent literature on this fascinating topic.
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Affiliation(s)
- Adrian J Wills
- Department of Neurology, Queen's Medical Centre, Nottingham, UK.
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