Gluten sensitivity: From gut to brain

Neurological symptoms

Reports suggest ataxia and neuropathy (loss of coordination and loss of senses such as feeling) are the most common neurological problems found in people with coeliac disease.

Initial research on neurological symptoms of coeliac disease suggested that symptoms were caused by vitamin deficiency. However, more recent research suggests that the symptoms have an immune-mediated pathogenesis.

Diagnosis

Most people who present with neurological manifestations of gluten sensitivity have no gut symptoms. This review paper highlights the diagnosis pathway the research team use for people who have neurological symptoms that could be due to gluten sensitivity, including blood tests and biopsy.

Blood tests

Research has shown that some people with coeliac disease  who do not have obvious gut symptoms may not produce antibodies for transglutaminase-2 (TG2), the antibodies used for screening purposes in coeliac disease. Antibodies for transglutaminase-3 (TG3) have been found in people with dermatitis herpetiformis and antibodies for transglutaminase-6 (TG6) have been found in people with neurological manifestations. However, tests for TG3 and TG6 antibodies are currently not widely available.

Biopsy

After serological screening the next step in diagnosis is a gut biopsy. Gut damage may not always be typical in someone who has gluten sensitivity with neurological manifestations. Referral to a specialist centre should be considered if no alternative cause can be found for the neurological symptoms.

Genetics

HLA-DQ2 and HLA-DQ8 are genes that have been found in people with coeliac disease. They can not be used for diagnosis as they are also present in people without coeliac disease. However, gluten sensitivity is unlikely in those who are tested negative for HLA genes. The HLA genes can be tested to exclude gluten sensitivity.

The DQ8 gene was more common in people in the Sheffield neurology cohort who had no gut damage and neurological symptoms of gluten sensitivity compared with people with coeliac disease seeing the gastroenterologists. This suggests there are differences in the genetic make-up between people with neurological symptoms and in those whose condition mainly affects the gastrointestinal system.

Further information

Further information on the range of neurological manifestations of gluten sensitivity that have been encountered by this research team can be found in their research paper.

You can also find out more information on the current research being carried out by the research team on neurology and coeliac disease in the previous edition of Professional eXG.

References

Hadjivassiliou M, Sanders D et al (2010) Gluten sensitivity: from gut to brain. Lancet Neurology. 9:318-330