Small Fibers neuropathy & Gluten
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Gluten Sensitivity Neuropathy (Celiac Disease)
This is a proposed autoimmune disorder induced by celiac disease. Wheat, barley, and oats arecomposed of gluten that may induce an antibody reaction in susceptible individuals. Theseantibodies are thought to be directed against Purkinje cells and other nervous system tissueleading to a variety of disorders including cerebellar ataxia, neuropathy, and myoclonus, mean age 48, These included ataxia , peripheral neuropathy , myopathy , ataxia with myoclonus , myelopathy , and dementia . The same author has reportedup to 40% of patients with idiopathic peripheral neuropathy have anti-gliadin antibodies .
The neuromuscular manifestations include sensorimotor axonal neuropathy, axonal motor, andmononeuropathy multiplex. All patients were found to have anti-gliadin antibodies, either IgG orIgA. Of all patients with positive antibodies, only 35% have an abnormal intestinal biopsy,suggesting that neurologic symptoms may occur without GI symptoms. HLA DQ2 is found in90% of patients with celiac disease so this offers an additional confirmatory test. Further study isneeded of this potentially important cause of neurologic illness.
B-12 deficiency may be caused by a number of malabsorption syndromes, most commonlypernicious anemia, which accounts for well over 80% of all cases of B-12 deficiency. In up to10% of patients, the cobalamin deficiency may be due to food cobalamin malabsorption, whichresults from achlorhydria and an inability to separate cobalamin from food due to inadequategastric acidity. A number of other malabsorptive syndromes of the lower gut, such as bacterialovergrowth, tapeworm infestation, Crohn's disease, and ulcerative colitis, may also result incobalamin deficiency (Green and Kinsella 1995; Savage and Lindenbaum 1995).Post gastroplasty neuropathy and Strachan's syndrome remain a mystery in terms of the exactetiology but are probably polynutritional in origin, with a heavy emphasis on thiamin deficiency.
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