Saturday, May 21, 2011

Higher Rates of Celiac Disease in People with Multiple Sclerosis -5-10 times!!!

Is Celiac disease a "Brain" disease? Is Gluten sensitivity more commonly a brain disease than an intestinal disease, in this case villous atrophy? Here is more evidence that this may be so. And it may be due to increase levels of circulation auto-antibodies as is found in this study.

The study by a team in Spain, helps us understand the prevalence of celiac disease (CD) in a group of MS sufferers- 11.1%, but the team rightly questions both the myth of the typical presentation of the adult celiac victim (most don't have diarrhea), and the emphasis on the small bowel biopsy as the only means of diagnosis. I too don't think small bowel biopsy is the only means of diagnosing CD.

They don't report how many, if any, of their patients with a normal biopsy and positive serology were asked to go on a gluten-free diet, and how many improved on a gluten free diet.  They did recommend such a trial for 6 months to rule out CD. (This group would be "non-celiac gluten sensitivity" if they responded positively to the diet (and supplementation of nutrients, especially B vitamens and vitamins D)). Perhaps they will do this study in the future.
They rightly assessed first degree relatives and found a prevalence rate of 32%!

Jefferson Adams comments on the study in 05/11/2011 - People with multiple sclerosis and their first-generation relatives have higher rates of celiac disease than the general population, according to a report by a research team in Spain.

For the study, a research team led by Dr. Luis Rodrigo of University Hospital, Central Asturias, Spain looked at rates of serologic, genetic, and histological disease markers in 72 multiple sclerosis patients and 126 of their first-degree relatives. They then compared the results against data from 123 healthy control subjects.
The team found rates of celiac disease among multiple sclerosis patients that are 5 to 10 times higher than rates for the general population worldwide, which average between 1% and 2%.

The team found similar levels of HLA-DQ2 markers in both multiple sclerosis patients (29%) and controls (26%) (NS). They found eight multiple sclerosis patients (11.1%) who showed mild or moderate villous atrophy (Marsh III type) on duodenal biopsy. Results also showed that 26 of 126 first-degree relatives (32%) had celiac disease.Multiple Sclerosis patients also displayed increased frequency of circulating auto-antibodies such as anti-TPO in 19 (26%), ANA in 11 (15%) and AMA in 2 (3%).

The authors write:
"The findings from duodenal biopsies are still considered by most experts as the "cornerstone" or the "gold standard" for diagnosis of CD. However, this statement emphatic as it may sound, is currently being challenged, especially if we take into account the adult forms of CD. In cases with very high levels of anti-TGt-2 antibodies (>100 U/ml), the duodenal biopsy may be avoided, since in most cases (> 90%) such high levels are associated with the presence of villous atrophy [30]. When the histological results are normal, but the serology is positive and the clinical picture is suggestive of CD, the diagnostic uncertainty remains, and in such cases a gluten-free diet (GFD) could be recommended for at least 6 months, before definitely ruling out a CD."