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Gluten neuropathy: prevalence of neuropathic pain and the role of gluten-free diet

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Abstract

Background and aim

Peripheral neuropathy is a common extraintestinal manifestation of gluten sensitivity (gluten neuropathy). We aimed to establish the prevalence of neuropathic pain in patients with otherwise idiopathic PN and gluten sensitivity (positive antigliadin, endomysial, and/or transglutaminase antibodies, with or without enteropathy) and to describe any contributory factors.

Methods

All consecutive patients with gluten neuropathy (GN) attending a specialist gluten/neurology clinic were invited to participate. Pain was assessed via the DN4 questionnaire and the visual analog scale. Overall Neuropathy Limitations Scale was used to assess the severity of neuropathy. The Mental Health Index (MHI-5) was used to measure participants’ general mental health status.

Results

In total, 60 patients (76.7% males, mean age 69.9 ± 10.1 years) with GN were recruited. Neuropathic pain was present in 33 patients (55.0%). Comparison between groups of painful and not painful GN did not show significant differences regarding age, gender, neuropathy severity and neuropathy type. Patients with painless GN were more likely to be on a strict gluten-free diet (55.6 versus 21.2%, p = 0.006). Patients with painful GN presented with significantly worse MHI-5 score (75.9 ± 13.8 versus 87.4 ± 8.1, p < 0.001). Multivariate analysis showed that, after adjusting for age, gender and MHI-5, strict gluten-free diet was associated with lowering the odds of peripheral neuropathic pain by 88.7% (95% CI 47.2–97.6%, p = 0.006).

Conclusion

Neuropathic pain is very prevalent in GN and is associated with poorer mental health status. Strict gluten-free diet might be protective as it is associated with a significant reduction of the odds of peripheral neuropathic pain associated to GN.

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Acknowledgements

This is a summary of independent research supported by BRC and carried out at the National Institute for Health Research (NIHR) Sheffield Clinical Research Facility. The views expressed are those of the authors and not necessarily those of the BRC, NHS, the NIHR, or the Department of Health. We would like to thank all participants in the study.

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Authors and Affiliations

  1. Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK

    Panagiotis Zis, Ptolemaios Georgios Sarrigiannis, Dasappaiah Ganesh Rao & Marios Hadjivassiliou

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  1. Panagiotis Zis
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  2. Ptolemaios Georgios Sarrigiannis
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  3. Dasappaiah Ganesh Rao
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  4. Marios Hadjivassiliou
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PZ and MH: drafting/revising the manuscript, data collection statistical analysis, accept responsibility for conduct of research, and final approval. DGR and PGS: drafting/revising the manuscript, data collection, accept responsibility for conduct of research, and final approval.

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Correspondence to Panagiotis Zis.

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Panagiotis Zis, Dasappaiah Ganesh Rao, Ptolemaios Georgios Sarrigiannis, and Marios Hadjivassiliou have nothing to disclose.

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Zis, P., Sarrigiannis, P.G., Rao, D.G. et al. Gluten neuropathy: prevalence of neuropathic pain and the role of gluten-free diet. J Neurol 265, 2231–2236 (2018). https://doi.org/10.1007/s00415-018-8978-5

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  • DOI: https://doi.org/10.1007/s00415-018-8978-5

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