Flashcards in gluten Deck (15):
define gluten sensitivity
a state of heightened immunological responsiveness to ingested gluten in genetically susceptible individuals (marsh 1995)
what are some common neurological presentations of gluten sensitivity?
(sensorimotor axonal neuropathy, sensory gangliopathy)
myoclonic ataxia (hyperexcitable brain)
less common neurological manifestations of gluten include:
epilepsy with or without occipital calcifications
stiff person syndrome
what is gluten ataxia
sporadic idiopathic ataxia ( some familial cases described)
where serological markers of sensitivity to gluten are present
which antibodies are associated with gluten ataxia?
what is the outcome of treatment with gluten free diet for gluten ataxia
improvement of the ataxia within a year of strict gluten-free diet even in those without enteropathy (hadjivassiliou et al 2003)
what is gluten neuropathy
symmetrical sensorimotor length dependant neuropathy
caused by gluten insensitivty
26% of all neuropathies
34% of idiopathic neuropathies
what is the effect of treatment with a gluten free diet for gluten neuropathy?
Neurophysiological evidence of improvement of
the neuropathy within a year of adherence to a
strict gluten-free diet
Hadjivassiliou et al 2006
what is gluten encephalopathy?
encephalopaphy ( meaning disease, damage or malfunction of the brain) caused by gluten insensitivity
causes episodic often severe and intractable headaches, rarely with focal deficits
headache improves on gluten free diet
white matter changes do not progress but do not resolve either
what are the differences between patients with CD presenting with ataxia vs GI symptoms?
patients presenting with neurological dysfunction are diagnosed with CD much later
neurologically more severely affected at time or presentation
diet has stabilising effect but they remain disabled
what is non-coeliac gluten sensitivity
patients who benefit (GI or neurological symptoms) from a gluten free diet in the absense of enteropathy
most positive for AGA and may have a low titre for TG2 antibodies
what percent of non neurologically gluten sensitive patients have enteropathy on biopsy?
37% no enteropathy but have HLA DQ2
what is TG2
transglutimase 2 is a protein that was found to be the autoantigen in CD
what percent of those with CD were found to have TG6
73% with positive antigliadan antibodies and ataxia