Neurológia pre prax 6/2015

Gluten neuropathy

Gluten-related disorders (GRD) is a term used to describe a spectrum of diseases related to the ingestion of the food containing gluten, a cereal protein contained in wheat, rye and barley. Celiac disease and non-celiac gluten sensitivity are the most prominent clinical units of this group with a high prevalence in general population and variable clinical manifestation in both the cases. Among others, they may present with neurological symptoms, mainly polyneuropathy, which is found in about 50 % of celiac patients. So called gluten neuropathy is usually symmetric chronic, sensory-motor and axonal. Asymetric forms as well as small fiber neuropathy can also be found in GRD patients. Besides medical history and clinical picture, diagnosis of GRD (particularly celiac disease) is confirmed by serological methods (evaluating the presence of antibodies against tissue transglutaminase, endomysium and gliadin, a part of gluten molecule), histology (confirming the inflammatory changes in duodenal mucosa biopsy samples) or evidence of the association with HLA II antigens. Confirmation may also be performed by evaluation of the effect of gluten-free diet, which represents a key therapeutical intervention in the prevention of development the clinical symptoms related to GRD. In gluten neuropathy, the diet leads to clinical stabilisation and prevention of the disease progession likely than to a clinical regression of the symptoms and signs.

Keywords: celiac disease, gliadin, gluten, polyneuropathies, gluten-free diet.