Celiac.com 02/08/2016 - When doctors talk about non-celiac gluten sensitivity (NCGS), they are usually talking about people who have gastrointestinal symptoms without enteropathy, and for whom a gluten-free diet (GFD) provides some relief of symptoms.
The research team included Marios Hadjivassiliou, Dasappaiah G Rao, Richard A Grìnewald, Daniel P Aeschlimann, Ptolemaios G Sarrigiannis, Nigel Hoggard, Pascale Aeschlimann, Peter D Mooney and David S Sanders.
The team compared clinical, neurophysiological, and imaging data from celiac disease patients and NCGS patients who presented with neurological dysfunction, and who had regular assessment and follow up over a 20-year period. The study included 562 out of total 700 patients. The team excluded patients who had no bowel biopsy to confirm celiac disease, no HLA type available, and/or failed to adhere to GFD.
All patients presented with neurological dysfunction and had circulating anti-gliadin antibodies. The most common neurological problems were cerebellar ataxia, peripheral neuropathy, and encephalopathy.
Out of 562 patients, 228 (41%) had evidence of enteropathy (Group 1, celiac disease) and 334 (59%) did not (Group 2, NCGS). There was a greater proportion of patients with encephalopathy in Group 1 and with a greater proportion of neuropathy in Group 2. The severity of ataxia was about the same between the two groups. Patients in Group 1 showed more severe neuropathy.
Patients from both groups responded well to a gluten-free diet. Anti-tissue transglutaminase (TG2) antibodies were found in 91% of patients in Group 1 and in 29% of patients in Group 2.
Researchers saw no difference between those patients in Group 2 with HLA-DQ2/DQ8 and those without, or between those with positive TG2 compared to those with negative TG2 antibodies. Both groups showed similar serological positivity for TG6 antibodies, at 67% and 60%, respectively.
The results of this study show that patients with celiac disease and NCGS have similar neurological manifestations, which respond well to a gluten-free diet. This suggests that the two conditions share common pathophysiological mechanisms.