Small-Fiber Neuropathy/Neuronopathy Associated With Celiac Disease

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Abstract
Celiac disease (CD) is an autoimmune disease of the small intestine, which results from ingestion of gluten (the storage protein of wheat) in genetically susceptible people. There is an HLA antigen association with specific DQ2 and DQ8 alleles. Celiac disease is a common disease and increasingly recognized in North America. The prevalence is estimated at 1 in 133 to 1 in 250.1,2 Celiac disease may be associated with extra–gastrointestinal tract conditions such as anemia, osteoporosis, or neurological disorders, often without the presence of gastrointestinal tract symptoms. Signs and symptoms of a peripheral neuropathy constitute the most common neurological manifestation of CD.3 Whether patients with idiopathic neuropathy should undergo testing for CD is controversial.4,5 We previously reported that more than 50% of patients with CD and symptoms of peripheral neuropathy seen in our center had normal results of nerve conduction studies, suggesting the possibility of a small-fiber neuropathy.6 In this study, we describe skin biopsy results to assess epidermal nerve fiber (ENF) density7 in patients with CD and symptoms of neuropathy, which could aid in defining these patients.