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Published in: BMC Neurology 1/2011

Open Access 01-12-2011 | Research article

Prevalence of celiac disease in multiple sclerosis

Authors: Luis Rodrigo, Carlos Hernández-Lahoz, Dolores Fuentes, Noemí Alvarez, Antonio López-Vázquez, Segundo González

Published in: BMC Neurology | Issue 1/2011

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Abstract

Background

Celiac disease (CD) is a common systemic disease related to a permanent intolerance to gluten and is often associated with different autoimmune and neurological diseases. Its mean prevalence in the general population is 1-2% worldwide. Our aim was to study the prevalence of celiac disease in a prospective series of Multiple Sclerosis (MS) patients and their first-degree relatives.

Methods

We analyzed the prevalence of serological, histological and genetic CD markers in a series of 72 MS patients and in their 126 first-degree relatives, compared to 123 healthy controls.

Results

Tissue IgA-anti-transglutaminase-2 antibodies were positive in 7 MS patients (10%), compared to 3 healthy controls (2.4%) (p < 0.05). OR: 5.33 (CI-95%: 1.074-26.425). No differences were found in HLA-DQ2 markers between MS patients (29%) and controls (26%) (NS).
We detected mild or moderate villous atrophy (Marsh III type) in duodenal biopsies, in 8 MS patients (11.1%). We also found a high proportion of CD among first-degree relatives: 23/126 (32%). Several associated diseases were detected, mainly dermatitis 41 (57%) and iron deficiency anemia in 28 (39%) MS patients. We also found in them, an increased frequency of circulating auto-antibodies such as anti-TPO in 19 (26%), ANA in 11 (15%) and AMA in 2 (3%).

Conclusions

We have found an increased prevalence of CD in 8 of the 72 MS patients (11.1%) and also in their first-degree relatives (23/126 [32%]). Therefore, increased efforts aimed at the early detection and dietary treatment of CD, among antibody-positive MS patients, are advisable.
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Literature
1.
go back to reference Compston A, Coles A: Multiple sclerosis. Lancet. 2008, 372: 1.502-17. 10.1016/S0140-6736(08)61620-7.CrossRef Compston A, Coles A: Multiple sclerosis. Lancet. 2008, 372: 1.502-17. 10.1016/S0140-6736(08)61620-7.CrossRef
2.
go back to reference Chandran S, Hunt D, Joannides A, et al: Myelin repair: the role of stem and precursor cells in multiple sclerosis. Philos Trans R Soc London Biol Sci. 2008, 363: 171-83. 10.1098/rstb.2006.2019.CrossRef Chandran S, Hunt D, Joannides A, et al: Myelin repair: the role of stem and precursor cells in multiple sclerosis. Philos Trans R Soc London Biol Sci. 2008, 363: 171-83. 10.1098/rstb.2006.2019.CrossRef
3.
go back to reference Sawcer S, Compston A: Multiple sclerosis: Light at the end of the tunnel. Eur J Hum Genet. 2006, 14: 257-8. 10.1038/sj.ejhg.5201561.CrossRefPubMed Sawcer S, Compston A: Multiple sclerosis: Light at the end of the tunnel. Eur J Hum Genet. 2006, 14: 257-8. 10.1038/sj.ejhg.5201561.CrossRefPubMed
4.
go back to reference Tsutsui S, Stys PK: Degeneration versus autoimmunity in Multiple Sclerosis. Ann Neurol. 2009, 66: 711-3. 10.1002/ana.21845.CrossRefPubMed Tsutsui S, Stys PK: Degeneration versus autoimmunity in Multiple Sclerosis. Ann Neurol. 2009, 66: 711-3. 10.1002/ana.21845.CrossRefPubMed
5.
go back to reference Lincoln JA, Cook SD: An overview of gene-epigenetic-environmental contributions to MS causation. J Neurol Sci. 2009, 286: 54-7. 10.1016/j.jns.2009.06.037.CrossRefPubMed Lincoln JA, Cook SD: An overview of gene-epigenetic-environmental contributions to MS causation. J Neurol Sci. 2009, 286: 54-7. 10.1016/j.jns.2009.06.037.CrossRefPubMed
6.
go back to reference Tintore M, Rovira A, Río J, et al: New diagnostic criteria for multiple sclerosis: application in first demyelinating episode. Neurology. 2003, 60: 27-30.CrossRefPubMed Tintore M, Rovira A, Río J, et al: New diagnostic criteria for multiple sclerosis: application in first demyelinating episode. Neurology. 2003, 60: 27-30.CrossRefPubMed
7.
go back to reference Carrol WM: Oral Therapy for Multiple Sclerosis. N Engl J Med. 2010, 362: 456-8. 10.1056/NEJMe0912019.CrossRef Carrol WM: Oral Therapy for Multiple Sclerosis. N Engl J Med. 2010, 362: 456-8. 10.1056/NEJMe0912019.CrossRef
8.
go back to reference James MB, Scott BB: Celiac disease: the cause of the various associated disorders?. Eur J Gastroenterol Hepatol. 2001, 13: 1119-21. 10.1097/00042737-200109000-00022.CrossRefPubMed James MB, Scott BB: Celiac disease: the cause of the various associated disorders?. Eur J Gastroenterol Hepatol. 2001, 13: 1119-21. 10.1097/00042737-200109000-00022.CrossRefPubMed
10.
11.
go back to reference Kakar S, Nehra V, Murray JA, et al: Significance of intraepithelial lymphocytosis in small biopsy samples with normal mucosal architecture. Am J Gastroenterol. 2003, 98: 2027-33. 10.1111/j.1572-0241.2003.07631.x.CrossRefPubMed Kakar S, Nehra V, Murray JA, et al: Significance of intraepithelial lymphocytosis in small biopsy samples with normal mucosal architecture. Am J Gastroenterol. 2003, 98: 2027-33. 10.1111/j.1572-0241.2003.07631.x.CrossRefPubMed
12.
go back to reference Shor DB, Barzilai O, Ram M, et al: Gluten sensitivity in multiple sclerosis: experimental myth or clinical truth?. Ann N Y Acad Sci. 2009, 1173: 343-9. 10.1111/j.1749-6632.2009.04620.x.CrossRefPubMed Shor DB, Barzilai O, Ram M, et al: Gluten sensitivity in multiple sclerosis: experimental myth or clinical truth?. Ann N Y Acad Sci. 2009, 1173: 343-9. 10.1111/j.1749-6632.2009.04620.x.CrossRefPubMed
13.
go back to reference Polman CH, Reingold SC, Edan G, et al: Diagnostic criteria for multiple sclerosis: 2005 revisions to the "Mac Donald Criteria". Ann Neurol. 2005, 58: 840-6. 10.1002/ana.20703.CrossRefPubMed Polman CH, Reingold SC, Edan G, et al: Diagnostic criteria for multiple sclerosis: 2005 revisions to the "Mac Donald Criteria". Ann Neurol. 2005, 58: 840-6. 10.1002/ana.20703.CrossRefPubMed
14.
go back to reference Marine M, Fernández-Bañares F, Alsina M, et al: Impact of mass screening for gluten-sensitive enteropathy in working population. World J Gastroenterol. 2009, 15: 1331-8. 10.3748/wjg.15.1331.CrossRefPubMedPubMedCentral Marine M, Fernández-Bañares F, Alsina M, et al: Impact of mass screening for gluten-sensitive enteropathy in working population. World J Gastroenterol. 2009, 15: 1331-8. 10.3748/wjg.15.1331.CrossRefPubMedPubMedCentral
15.
go back to reference Fernández E, Riestra S, Rodrigo L, et al: Comparison of six human anti-transglutaminase ELISA-tests in the diagnosis of celiac disease in the Saharawi population. World J Gastroenterol. 2005, 11: 3762-6.CrossRefPubMedPubMedCentral Fernández E, Riestra S, Rodrigo L, et al: Comparison of six human anti-transglutaminase ELISA-tests in the diagnosis of celiac disease in the Saharawi population. World J Gastroenterol. 2005, 11: 3762-6.CrossRefPubMedPubMedCentral
16.
go back to reference Marsh MN: Gluten, major histocompatibility complex and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology. 1992, 102: 330-54.CrossRefPubMed Marsh MN: Gluten, major histocompatibility complex and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ('celiac sprue'). Gastroenterology. 1992, 102: 330-54.CrossRefPubMed
17.
go back to reference Oberhuber G, Granditsch G, Vogelsang H: The histopathology of coeliac disease. Time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999, 11: 1185-94. 10.1097/00042737-199910000-00019.CrossRefPubMed Oberhuber G, Granditsch G, Vogelsang H: The histopathology of coeliac disease. Time for a standardized report scheme for pathologists. Eur J Gastroenterol Hepatol. 1999, 11: 1185-94. 10.1097/00042737-199910000-00019.CrossRefPubMed
18.
go back to reference Hadjivassiliou M, Sanders DS, Grünewald RA, et al: Gluten sensitivity: from gut to brain. Lancet Neurol. 2010, 9: 318-30. 10.1016/S1474-4422(09)70290-X.CrossRefPubMed Hadjivassiliou M, Sanders DS, Grünewald RA, et al: Gluten sensitivity: from gut to brain. Lancet Neurol. 2010, 9: 318-30. 10.1016/S1474-4422(09)70290-X.CrossRefPubMed
19.
go back to reference Kom T: Pathophysiology of multiple sclerosis. J Neurol. 2008, 255 (Suppl 6): 2-6. Kom T: Pathophysiology of multiple sclerosis. J Neurol. 2008, 255 (Suppl 6): 2-6.
20.
go back to reference López-Vázquez A, Rodrigo L, Fuentes D, et al: MHC class I chain related gene A (MICA) modulates the development of coeliac disease in patients with the high risk heterodimer DQA1*0501/DQB1*0201. Gut. 2002, 50: 336-40.CrossRefPubMedPubMedCentral López-Vázquez A, Rodrigo L, Fuentes D, et al: MHC class I chain related gene A (MICA) modulates the development of coeliac disease in patients with the high risk heterodimer DQA1*0501/DQB1*0201. Gut. 2002, 50: 336-40.CrossRefPubMedPubMedCentral
21.
go back to reference Fasano A, Berti I, Gerarduzzi T, et al: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003, 163: 286-92. 10.1001/archinte.163.3.286.CrossRefPubMed Fasano A, Berti I, Gerarduzzi T, et al: Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003, 163: 286-92. 10.1001/archinte.163.3.286.CrossRefPubMed
22.
go back to reference Shan L, Molberg Ø, Parrot I, et al: Structural basis for gluten intolerance in celiac sprue. Science. 2002, 297: 2275-9. 10.1126/science.1074129.CrossRefPubMed Shan L, Molberg Ø, Parrot I, et al: Structural basis for gluten intolerance in celiac sprue. Science. 2002, 297: 2275-9. 10.1126/science.1074129.CrossRefPubMed
23.
go back to reference Molberg O, McAdam SN, Sollid LM: Role of tissue transglutaminase in celiac disease. J Pediatr Gastroenterol Nutr. 2000, 30: 232-40. 10.1097/00005176-200003000-00005.CrossRefPubMed Molberg O, McAdam SN, Sollid LM: Role of tissue transglutaminase in celiac disease. J Pediatr Gastroenterol Nutr. 2000, 30: 232-40. 10.1097/00005176-200003000-00005.CrossRefPubMed
24.
go back to reference Maiuri L, Ciacci C, Ricciardelli I, et al: Association between innate response to gliadin and activation of pathogenic T cells in celiac disease. Lancet. 2003, 362: 30-7. 10.1016/S0140-6736(03)13803-2.CrossRefPubMed Maiuri L, Ciacci C, Ricciardelli I, et al: Association between innate response to gliadin and activation of pathogenic T cells in celiac disease. Lancet. 2003, 362: 30-7. 10.1016/S0140-6736(03)13803-2.CrossRefPubMed
25.
go back to reference Dieterich W, Ehnis T, Bauer M, et al: Identification of tissue transglutaminase as the auto-antigen of celiac disease. Nat Med. 1997, 3: 797-801. 10.1038/nm0797-797.CrossRefPubMed Dieterich W, Ehnis T, Bauer M, et al: Identification of tissue transglutaminase as the auto-antigen of celiac disease. Nat Med. 1997, 3: 797-801. 10.1038/nm0797-797.CrossRefPubMed
26.
go back to reference Tursi A, Brandimarte G, Giorgetti GM: Prevalence of anti-tissue transglutaminase antibodies in different degrees of intestinal damage in celiac disease. J Clin Gastroenterol. 2003, 36: 219-21. 10.1097/00004836-200303000-00007.CrossRefPubMed Tursi A, Brandimarte G, Giorgetti GM: Prevalence of anti-tissue transglutaminase antibodies in different degrees of intestinal damage in celiac disease. J Clin Gastroenterol. 2003, 36: 219-21. 10.1097/00004836-200303000-00007.CrossRefPubMed
27.
go back to reference Esteve M, Rosinach M, Fernández-Bañares F, et al: Spectrum of gluten sensitive enteropathy in first-degree relatives of coeliac patients:clinical relevance of lymphocytic enteritis. Gut. 2006, 55: 1739-45. 10.1136/gut.2006.095299.CrossRefPubMedPubMedCentral Esteve M, Rosinach M, Fernández-Bañares F, et al: Spectrum of gluten sensitive enteropathy in first-degree relatives of coeliac patients:clinical relevance of lymphocytic enteritis. Gut. 2006, 55: 1739-45. 10.1136/gut.2006.095299.CrossRefPubMedPubMedCentral
28.
go back to reference Dickey W, Hughes DF, McMillan SA: Disappearance of endomysial antibodies in treated celiac disease does not indicate histological recovery. Am J Gastroenterol. 2000, 95: 712-4. 10.1111/j.1572-0241.2000.01838.x.CrossRefPubMed Dickey W, Hughes DF, McMillan SA: Disappearance of endomysial antibodies in treated celiac disease does not indicate histological recovery. Am J Gastroenterol. 2000, 95: 712-4. 10.1111/j.1572-0241.2000.01838.x.CrossRefPubMed
29.
go back to reference Santaolalla R, Fernández-Bañares F, Rodríguez R, et al: Diagnostic value of duodenal anti-tissue transglutaminase antibodies in gluten-sensitive enteropathy. Aliment Pharmacol Ther. 2008, 27: 820-9. 10.1111/j.1365-2036.2008.03652.x.CrossRefPubMed Santaolalla R, Fernández-Bañares F, Rodríguez R, et al: Diagnostic value of duodenal anti-tissue transglutaminase antibodies in gluten-sensitive enteropathy. Aliment Pharmacol Ther. 2008, 27: 820-9. 10.1111/j.1365-2036.2008.03652.x.CrossRefPubMed
30.
go back to reference Vivas S, Ruiz de Morales JG, Riestra S, et al: Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World J Gastroenterol. 2009, 15: 4775-80. 10.3748/wjg.15.4775.CrossRefPubMedPubMedCentral Vivas S, Ruiz de Morales JG, Riestra S, et al: Duodenal biopsy may be avoided when high transglutaminase antibody titers are present. World J Gastroenterol. 2009, 15: 4775-80. 10.3748/wjg.15.4775.CrossRefPubMedPubMedCentral
31.
go back to reference Fernández-Bañares F, Esteve M, Salas A, et al: Systematic evaluation of causes of chronic watery diarrea with functional characteristics. Am J Gastroenterol. 2007, 102 (11): 2520-2528.CrossRefPubMed Fernández-Bañares F, Esteve M, Salas A, et al: Systematic evaluation of causes of chronic watery diarrea with functional characteristics. Am J Gastroenterol. 2007, 102 (11): 2520-2528.CrossRefPubMed
32.
go back to reference Roche Herrero MC, Arcas Martínez J, Martínez-Bermejo A, et al: The prevalence of headache in a population of patients with coeliac disease. Rev Neurol. 2001, 32: 301-9.PubMed Roche Herrero MC, Arcas Martínez J, Martínez-Bermejo A, et al: The prevalence of headache in a population of patients with coeliac disease. Rev Neurol. 2001, 32: 301-9.PubMed
33.
go back to reference Zelnik N, Pacht T, Obeid R, et al: Range of neurologic disorders in patients wih celiac disease. Pediatrics. 2004, 113: 1672-6. 10.1542/peds.113.6.1672.CrossRefPubMed Zelnik N, Pacht T, Obeid R, et al: Range of neurologic disorders in patients wih celiac disease. Pediatrics. 2004, 113: 1672-6. 10.1542/peds.113.6.1672.CrossRefPubMed
34.
go back to reference Bushara KO: Neurologic presentation of celiac disease. Gastroenterology. 2005, 128: S92-7. 10.1053/j.gastro.2005.02.018.CrossRefPubMed Bushara KO: Neurologic presentation of celiac disease. Gastroenterology. 2005, 128: S92-7. 10.1053/j.gastro.2005.02.018.CrossRefPubMed
35.
go back to reference Wong D, Dwinnel M, Schulzer M, et al: Ataxia and the role of antigliadin antibodies. Can J Neurol Sci. 2007, 34: 193-6.CrossRefPubMed Wong D, Dwinnel M, Schulzer M, et al: Ataxia and the role of antigliadin antibodies. Can J Neurol Sci. 2007, 34: 193-6.CrossRefPubMed
36.
go back to reference Hadjivassiliou M, Aeschlimann P, Strigun A, et al: Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol. 2008, 64: 332-43. 10.1002/ana.21450.CrossRefPubMed Hadjivassiliou M, Aeschlimann P, Strigun A, et al: Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol. 2008, 64: 332-43. 10.1002/ana.21450.CrossRefPubMed
Metadata
Title
Prevalence of celiac disease in multiple sclerosis
Authors
Luis Rodrigo
Carlos Hernández-Lahoz
Dolores Fuentes
Noemí Alvarez
Antonio López-Vázquez
Segundo González
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2011
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-11-31

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