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Coeliac disease is an inflammatory condition of the small intestine characterised by villous atrophy and crypt hyperplasia induced by dietary gluten in genetically susceptible people, possibly affecting 1:300-1:100 of the population. The most common symptoms are diarrhoea, weight loss, and malabsorption, which recover with a gluten free diet. Coeliac disease may remain silent, but it can lead to various non-gastrointestinal complications such as osteoporosis, infertility, or lymphoma. Gluten free diet is beneficial in preventing these complications, and the risk seems to be altogether low in treated patients. The diagnosis is established by the finding of small bowel villous atrophy and clinical or histological remission on gluten free diet. 1 Untreated coeliac disease may present with various neurological manifestations such as cerebellar ataxia, epilepsy, or brain atrophy. 2- 6 Association between peripheral neuropathy and coeliac disease has been described, 7- 9 and recently, Hadjivassiliou with his colleagues reported nine patients in whom neuromuscular disorder was a presenting feature of coeliac disease. 9 Diabetes and alcohol misuse are the most common causes of peripheral neuropathy in developed countries. Other well established causes of neuropathy include hereditary, metabolic, toxic, infectious, inflammatory, ischaemic, and paraneoplastic disorders. However, despite extensive evaluation, the aetiology remains unknown in up to 20% of patients with neuropathy even in very specialised neurological units. 10, 11
The role of gluten free diet has remained unknown in modifying symptoms and findings of neuropathy in coeliac disease. Gluten free diet may reverse or at least slow down the progression of peripheral neuropathy and on the other hand, transgressions in gluten free diet may exacerbate neurological disorders in coeliac disease. In one case report the symptoms disappeared after introducing gluten free diet. 8
The aim of this cross sectional study was to assess whether even patients with a well treated coeliac disease carry an increased risk of neuropathy.
METHODS
The study was carried out at the Department of Neurology in Tampere University Hospital. The study group comprised 26 patients with coeliac disease. The diagnosis of coeliac disease had been established according to current criteria of European Society for Paediatric Gastroenterology and Nutrition).
Table 1 Demographic data
Coeliac disease patients | Reflux disease patients | |
Number of patients (male/female) | 26 (7/19) | 23 (16/7) |
Mean age (range) (y) | 51 (22-77) |