Celiac Disease More Prevalent in Multiple Sclerosis

Megan Brooks

March 10, 2011

March 10, 2011 — Celiac disease is more prevalent in patients with multiple sclerosis (MS) and their close relatives than in the general population, clinicians from Spain report.

Increased efforts aimed at early detection and dietary treatment of celiac disease among MS patients with tissue IgA–antitransglutaminase-2 antibodies "are advisable," they conclude in a report published online March 7 in BMC Neurology.

"We have found a prevalence of celiac disease among MS patients that is 5 to 10 times higher compared with the general population all over the world, which is between 1% and 2%," said first study author Luis Rodrigo, MD, from the Gastroenterology Service, Hospital Universitario Central de Asturias, in Oviedo, Spain.

Dr. Rodrigo and his colleagues note, however, that celiac disease is often underdiagnosed and therefore underestimated.

"The practical point is to put these patients on a gluten-free diet and to observe the improvement of the neurological disease over time," he said in an email to Medscape Medical News.

Clinic Experience Fuels Study

Dr. Luis Rodrigo

Dr. Rodrigo and his associates recently saw a 30-year-old female patient with relapsing-remitting MS who developed abdominal pain with diarrhea and weight loss. She was diagnosed as having celiac disease, put on a gluten-free diet, and subsequently saw improvement not only in her digestive symptoms but also in her neurologic disturbances.

This experience led them to analyze the prevalence of serologic, histologic, and genetic celiac disease markers in 72 MS patients and 126 first-degree relatives, as well as 123 healthy controls.

They detected tissue IgA–antitransglutaminase-2 antibodies, a key serologic marker of celiac disease, in 7 MS patients (10%) but in only 3 controls (2.4%), a statistically significant difference (P < .05; odds ratio, 5.33; 95% confidence interval, 1.074 – 26.425).

They also detected mild or moderate villous atrophy (Marsh III type) in duodenal biopsy specimens from 8 MS patients (11.1%). There were no significant differences between MS and control patients in HLA-DQ2 and HLA-DQ8 genetic susceptibility markers of celiac disease.

In addition, 23 of 126 first-degree relatives of MS patients had celiac disease (32%).

The only differential parameter between MS patients with celiac disease and those without was the age at onset of MS, which was younger (35 ± 7 years old) in the former and older (44 ± 10 years old) in the latter (P < .05). All of the 8 MS patients with celiac disease were female.

Early Detection, Treatment Key

On the basis of their initial experience, the clinicians say they put all of the MS patients with celiac disease on a gluten-free diet "and all of them improved considerably both with respect to the gastrointestinal and to the neurological symptomatology in the follow-up period," they report.

"So the main message that we want to [get out] to doctors who attend MS patients is to perform clinical, serological, genetic, and histologic studies directed to find a possible associated [celiac disease]," Dr. Rodrigo told Medscape Medical News. "All these studies must be done in collaboration with a gastroenterologist expert in this field," he noted.

Jeffrey L. Gross, MD, from Associated Neurologists of Southern Connecticut in Fairfield, who was not involved in the study, said he too has had experience with a patient whose MS symptoms improved after their celiac disease was brought under control.

In a telephone interview with Medscape Medical News, he made the point that it is "sometimes difficult to say whether a person with celiac disease is having neurological symptoms on the basis of their celiac or whether it's just 2 conditions occurring simultaneously in the same individual."

He noted, however, that there is "a statistical link between Crohn's disease and MS and 1 of the 9 drugs now approved for MS is also approved for Crohn's disease, so there is a link between the gut and the brain somehow."

The study authors and Dr. Gross have disclosed no relevant financial relationships.

BMC Neurol. 2011;11:31. Published online March 7, 2011.

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