title: Neurological Dysfunction in Coeliac Disease and Non-Coeliac Gluten Sensitivity.
abstract: OBJECTIVE
  Non-coeliac gluten sensitivity (NCGS) refers to patients with primarily gastrointestinal symptoms without enteropathy that symptomatically benefit from gluten-free diet (GFD). Little is known about its pathophysiology, propensity to neurological manifestations, and if these differ from patients with coeliac disease (CD). We investigated the clinical and immunological characteristics of patients presenting with neurological manifestations with CD and those with NCGS.
  
  
  METHODS
  We compared clinical, neurophysiological, and imaging data of patients with CD and NCGS presenting with neurological dysfunction assessed and followed up regularly over a period of 20 years.
  
  
  RESULTS
  Out of 700 patients, 562 were included. Exclusion criteria included no bowel biopsy to confirm CD, no HLA type available, and failure to adhere to GFD. All patients presented with neurological dysfunction and had circulating anti-gliadin antibodies. Out of 562 patients, 228 (41%) had evidence of enteropathy (Group 1, CD) and 334 (59%) did not (Group 2, NCGS). The most common neurological manifestations were cerebellar ataxia, peripheral neuropathy, and encephalopathy. There was a greater proportion of patients with encephalopathy in Group 1 and with a greater proportion of neuropathy in Group 2. The severity of ataxia did not differ between the two groups. Patients in Group 1 had more severe neuropathy. All patients from both groups responded to gluten-free diet. Anti-tissue transglutaminase (TG2) antibodies were found in 91% of patients in Group 1 and in 29% of patients in Group 2. Comparison between those patients in Group 2 with HLA-DQ2/DQ8 and those without as well as those with positive TG2 compared with those with negative TG2 antibodies identified no differences within these subgroups. Serological positivity for TG6 antibodies was similar in the two groups (67 and 60%).
  
  
  CONCLUSIONS
  The neurological manifestations of CD and NCGS are similar and equally responsive to a GFD suggestive of common pathophysiological mechanisms.
authors.affiliation: Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Marios
authors.initials: M
authors.lastname: Hadjivassiliou
authors.affiliation: Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Dasappaiah G
authors.initials: DG
authors.lastname: Rao
authors.affiliation: Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grìnewald
authors.affiliation: Matrix Biology and Tissue Repair Research Unit, College of Biomedical and Life Sciences, School of Dentistry, Cardiff University, Cardiff, Wales, UK.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Aeschlimann
authors.affiliation: Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Ptolemaios G
authors.initials: PG
authors.lastname: Sarrigiannis
authors.affiliation: Academic Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Hoggard
authors.affiliation: Academic Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Pascale
authors.initials: P
authors.lastname: Aeschlimann
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mooney
authors.affiliation: Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000276:immunology; D015415:Biomarkers / Q000032:analysis; D002446:Celiac Disease / Q000178:diet therapy / Q000276:immunology* / Q000503:physiopathology* / Q000517:prevention & control; D055050:Diet, Gluten-Free; D005260:Female; D005983:Glutens / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology*; D012189:Retrospective Studies
chemical_list: D000906:Antibodies; D015415:Biomarkers; D005983:Glutens
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