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Celiac Disease, Beyond the Bowel: A Review of Its Neurological Manifestations.
Patel, SC, Shreya, D, Zamora, DI, Patel, GS, Grossmann, I, Rodriguez, K, Soni, M, Joshi, PK, Sange, I
Cureus. 2021;13(12):e20112
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Plain language summary
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.
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Prevalence of osteoporosis and osteopenia in men and premenopausal women with celiac disease: a systematic review.
Ganji, R, Moghbeli, M, Sadeghi, R, Bayat, G, Ganji, A
Nutrition journal. 2019;18(1):9
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Coeliac disease (CD) is an autoimmune disorder and is known to be associated with a decrease in bone mineral density (BMD). Findings suggest 40-70% of patients with coeliac disease (CD) have low BMD, however this prevalence has been reported without considering confounding variables, such as age, menopause status, lifestyle factors and co-morbidities. The purpose of this review was to show the prevalence of osteoporosis and osteopenia in men and premenopausal women with coeliac disease (CD). This systematic review included 19 studies representing 563 subjects. Based on the current literature the pooled prevalence of osteoporosis was 14.4% and osteopenia was 39.6%. According to these results, the authors conclude bone loss is more prevalent in those with CD however larger case-controlled studies are required to adjust for confounding factors.
Abstract
BACKGROUND Celiac disease (CD) is known as a reason of metabolic osteopathy. Progression of non-invasive methods such as bone densitometry has shown that an important ratio of CD cases is faced with impaired bone mass and such cases are prone to bone fractures. Variety of low bone mineral density in CD is probably because of ignored confounding factors such as age, menopause, and drug. The aim of our study was to systematically review the osteoporosis and osteopenia incidences among premenopausal females and males with CD. METHODS This systematic review was done based on preferred reporting items for systematic reviews (PRISMA) guidelines. PubMed and Scopus and Cochran databases were searched according to the relevant medical subject headings (MeSH) of CD and bone mineral density until 2018. Prevalence of osteopenia and osteoporosis were used as effect size for meta-analysis. Cochrane Q (p < 0.05) and I2 index were presented to reveal the heterogeneity. RESULTS 54 eligible full text reviews were included and nineteen selected for data extraction. Eleven articles didn't have our inclusion criteria and had ignored confounding factors like age and menopause, and we excluded; data extraction was done in eight studies. A total of 563 premenopausal women and men who were from, UK, Brazil, India, Hungary, and Poland were included. The pooled prevalence of osteoporosis was 14.4% [95%CI: 9-20.5%] (Cochrane Q = 7.889, p = 0.96, I2 = 49.29%), and osteopenia was 39.6% [31.1-48.8%] (Cochrane Q = 14.24, p = 0.07, I2 = 71.92%), respectively. CONCLUSION Our findings suggest that bone loss is more prevalent in celiac disease and can be associated with increased risk of fracture. However, but results are pooled prevalence and we need more case -control studies with more sample size and consideration of confounding factors.