Neurological Deficits in Newly Diagnosed Celiacs a Reality

In patients with a new diagnosis of celiac disease, researchers assessed the presence of neurologic deficits and examined whether the presence of antibodies to transglutaminase 6 (TG6) increases the risk of neurologic defects.

• Clinical Gastroenterology and Hepatology Journal ¹

The study sample consisted of 100 consecutive patients who received a new diagnosis of celiac disease based on gastroscopy and duodenal biopsy.

Neurologic deficits were common and 40% had circulating antibodies against TG6 in a prospective cohort study of patients with a new diagnosis of celiac disease at a gastroenterology clinic.

In patients with TG6 autoantibodies, a significant reduction in the volume of specific brain regions was noted, providing evidence of a link between autoimmunity to TG6 and brain atrophy in celiac disease patients.

Early diagnosis, increased awareness of neurological manifestations among clinicians and strengthening patients’ adherence to a strict gluten-free diet to avoid permanent neurological disability are needed.

The Study ²

Methods

We performed a prospective cohort study at a secondary-care gastroenterology center of 100 consecutive patients who received a new diagnosis of celiac disease based on gastroscopy and duodenal biopsy. We collected data on neurologic history, and patients were evaluated in a clinical examination along with magnetic resonance imaging of the brain, magnetic resonance (MR) spectroscopy of the cerebellum, and measurements of antibodies against TG6 in serum samples. The first 52 patients recruited underwent repeat MR spectroscopy at 1 year after a gluten-free diet (GFD). The primary aim was to establish if detection of antibodies against TG6 can be used to identify patients with celiac disease and neurologic dysfunction.

Results

• Gait instability was reported in 24% of the patients, persisting sensory symptoms in 12%, and frequent headaches in 42%
• Gait ataxia was found in 29% of patients, nystagmus in 11%, and distal sensory loss in 10%
• 60% of patients had abnormal results from magnetic resonance imaging
• 47% had abnormal results from MR spectroscopy of the cerebellum, and
• 25% had brain white matter lesions beyond that expected for their age group
• Antibodies against TG6 were detected in serum samples from 40% of patients—these patients had significant atrophy of subcortical brain regions compared with patients without TG6 autoantibodies
• In patients with abnormal results from MR spectroscopy of the cerebellum, those on the GFD had improvements detected in the repeat MR spectroscopy 1 year later

Conclusions

In a prospective cohort study of patients with a new diagnosis of celiac disease at a gastroenterology clinic, neurologic deficits were common and 40% had circulating antibodies against TG6. We observed a significant reduction in volume of specific brain regions in patients with TG6 autoantibodies, providing evidence for a link between autoimmunity to TG6 and brain atrophy in patients with celiac disease.

There is a need for early diagnosis, increased awareness of the neurologic manifestations among clinicians, and reinforcement of adherence to a strict GFD by patients to avoid permanent neurologic disability.

• ¹ https://www.mdlinx.com/journal-summaries/wheat-headaches-ataxia-peripheral-neuropathy-brain/2019/07/23/7573134/?spec=gastroenterology
• ² https://www.cghjournal.org/article/S1542-3565(19)30278-2/fulltext?rss=yes