Neurological Manifestation of Coeliac Disease with particular Emphasis on Gluten Ataxia and Immunological injury, a Review Article.
Gastroenterology and Hepatology from Bed to Bench,
26 January 2021
Coeliac disease (CD) is a gluten induced enteropathy affecting 1% of the population and has extra intestinal manifestations. One of such expression involves nervous system and CD may present as gluten ataxia (GA), peripheral neuropathy and epileptiform disorder among others. Considerable controversy exists on the exact pathophysiological mechanism of gluten leading to ataxia. It is however, clear that in intestinal axis tissue transglutaminase 2 (tTG2) is the primary target but in nervous system tTG6 may be the causative antigen although its exact role is not clear. Furthermore, it has also been postulated that anti-gangliodise antibodies may be playing some role in causation of central pathology if not the key contender. Moreover, the association of neurological injury with non-coeliac gluten sensitivity (NCGS), a related but pathologically different condition points towards an independent mechanism of neuronal injury by gluten in the absence of CD. This review will touch on the salient features of CD and nervous system and will highlight current controversies in relation to gluten and GA.