Neuropathy associated with gluten sensitivity

M Hadjivassiliou ^1*, R A Grunewald ¹, R H Kandler ¹, A K Chattopadhyay ², J A Jarratt ³, D S Sanders ⁴, B Sharrack ¹, S Wharton ⁵ and GAB Davies-Jones ⁶

¹ Royal Hallamshire Hospital, United Kingdom
² The Royal Hallamshire Hospital, Sheffield, United Kingdom
³ The Royal Hallamshire Hospital, Sheffield, UK, United Kingdom
⁴ Department of Gastroenterology, The Royla Hallamshire Hospital, Sheffield, United Kingdom
⁵ University of Sheffield, United Kingdom
⁶ The Royal Hallamshire Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: m.hadjivassiliou{at}sheffield.ac.uk.

Accepted 30 June 2006

Abstract

Objective: To prospectively study the clinical, neurophysiological, neuropathological characteristics of axonal neuropathies associated with positive antigliadin antibodies and the prevalence of such neuropathy within a cohort of patients with sporadic axonal neuropathy.

Methods: Prospective screening (using antigliadin, antiendomysium and tissue transglutaminase antibodies) of patients with peripheral neuropathy attending a neurology clinic.

Results: A total of 215 patients with axonal neuropathy were screened. 141 had symmetrical sensorimotor neuropathy, 47 mononeuropathy multiplex, 17 motor neuropathy and 10 small fibre neuropathy. Despite extensive investigations of the 215 patients 140 had idiopathic neuropathy. Positive IgG with or without IgA antigliadin antibodies was found in 47/140 (34%) of the idiopathic cases. This compares to 12% prevalence of these antibodies in the healthy controls. The prevalence of biopsy proven coeliac disease (CD) in the idiopathic group was at least 9% as compared to 1% prevalence of CD in the healthy population. The clinical features of 100 patients (47 from the prevalence study and 53 referred from elsewhere) with gluten neuropathy included a mean age at onset of 55 years (range 24 to 77) and a mean duration of the neuropathy of 9 years (range 1 to 33). Gluten sensitive enteropathy was present in 29%. The HLA types associated with CD were found in 80%.

Conclusions: Gluten sensitivity may be aetiologically linked to a substantial number of idiopathic axonal neuropathies.

Keywords: axonal neuropathy, coeliac disease, gluten neuropathy, gluten sensitivity

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