Nevrologiske og psykiske symptomer ved cøliaki : En litteraturstudie

Abstract

Neurological and psychological symptoms in coeliac disease Background: Coeliac disease is a common disease, occuring in at least 1% of the population. There has been a change in the presentation of the disease; less patients present with the classical symptoms of diarrhoea, weightloss and malabsorption, and more patients present with extraintestinal symptoms. Content: This essay is a litterature review on neurological and psychological symptoms in coeliac disease and the possible association between gluten sensitivity and neurological symptoms. It includes a discussion of possible pathomechanisms. To begin with, an introduction on coeliac disease (pathomechanisms, diagnosis and presentation) is given. Results and conclusion: Several studies have tried to estimate the prevalence of coeliac disease in patients with idiopathic neurologic disease to prove an association. The results are not conclusive. Celiac patients seem to have more neurological deficits than the background population. Some studies show that these symptoms may respond to a gluten-free diet. This points towards a possible shared pathomechanism. Structural similarity between gliadin and neural antigens might be the basis for antibody-crossreactivity and the reason for neurological symptoms in coeliacs. A possible pathophysiological role of neuronal antibodies must be further investigated in animals. Another possible mechanism is that tissue-transglutaminase antibodies may cause systemic disease. Depression and anxiety is common in patients with coeliac disease, especially before treatment. Recent studies also indicate subtle cognitive deficits in coeliac patients. Decreased serum-levels of tryptophan, the precursor of serotonin, is suggested as a cause of depression in coeliac patients.