Celiac Disease Rates Not High in People with Multiple Sclerosis

Celiac.com 02/03/2023 - Multiple sclerosis is a chronic autoimmune disease of the central nervous system that affects individuals worldwide. People with multiple sclerosis often have other autoimmune diseases such as hypothyroidism, inflammatory bowel disease, rheumatoid arthritis, and diabetes, which suggests that there may be common genetic or environmental exposures between multiple sclerosis and other autoimmune diseases. 

Epidemiological studies have also shown that individuals with one autoimmune disease have an increased susceptibility to developing another autoimmune disease.

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Celiac disease is an autoimmune gluten-sensitive enteropathy that results in small intestinal lesions and malabsorption in affected individuals. Celiac disease develops based on genetic factors and mucosal immune response. 

Almost all individuals with celiac disease have HLA DR3-DQ2 and/or the DR4-DQ8. These HLA class II haplotypes have a strong association with multiple sclerosis. celiac disease is also associated with neurological manifestations and diseases such as ataxia, epilepsy, neuropathy, and multiple sclerosis. However, the exact relationship between celiac disease and multiple sclerosis is not well understood.

In order to evaluate the prevalence of celiac disease in multiple sclerosis cases, two researchers conducted a systematic review and meta-analysis using PubMed, Scopus, EMBASE, Web of Science, and Google Scholar. The search included all relevant studies published up to October 2022. 

The researchers independently searched all databases and also references of included studies. They included cross-sectional studies/case, articles which had been published in the English language, and studies in which the diagnostic criteria were biopsy of the duodenum. They excluded letters to editors, case reports, and RCT studies.

They found a total of 1,113 articles by literature search, and after deleting duplicates, 519 remained. Sixteen articles remained for meta-analysis. A total of 31,418 patients were evaluated and the total number of possible/confirmed cases was 124. Studies were published between 2004 and 2020, and the most published studies were from Italy. Five studies provided information regarding controls.

The pooled rates of this systematic review showed that celiac disease is not common in multiple sclerosis cases. However, the study did have some limitations. There were studies that used serologic evaluation for celiac disease diagnosis which were excluded. 

Additionally, there were no reports from some countries, and the control groups were different; as in some studies, the control group was healthy subjects, and in others, the control group was patients with other diseases except multiple sclerosis. The study authors suggest that larger multicenter studies from numerous countries are needed to fully understand the relationship between celiac disease and multiple sclerosis.

It is important to note that while the rates of celiac disease in multiple sclerosis patients may be low, patients with multiple sclerosis still suffer from a wide range of gastrointestinal manifestations such as dysphagia, constipation, and/or fecal incontinence. 

Dyspeptic symptoms and associated pain are also common in multiple sclerosis cases, which can negatively affect quality of life and interfere with daily activities. Because of this, it's important for doctors to be aware of the potential for these symptoms in multiple sclerosis patients, and to consider a range of possible causes.

Read more in the American Journal of Gastroenterology