13.1 Celiac Disease Associated With MENTAL Illness in Children and Correlated Screening Practices

Abstract

Celiac disease (CD) and non-celiac gluten sensitivity (NCGS) are associated autoimmune manifestations that can lead to psychiatric and neurological disorders, as well as treatment resistance. Mental illness is often the primary expression of CD or NCGS. Up to 85% of patients with histologically proven CD have no gastrointestinal symptoms. Untreated CD can lead to serious behavioral disorders, including a higher suicide risk. Child and adolescent psychiatrists treat such cases daily but may fail to screen for and/or recognize the association. We examine the literature on mental illness associated with CD and NCGS in the pediatric population to inform screening in psychiatry. A literature search using PubMed, Cochrane, and Google Scholar for CD or NCGS-related psychiatric comorbidities in the pediatric population aged 2 to 22 years using the terms “psychiatric,” “celiac,” “gluten,” “child OR adolescent OR pediatric,” and mental illness to include “depression,” “anxiety,” “mood disorders,” “attention deficit hyperactivity disorder,” “psychosis,” and "eating disorders" located 30 relevant articles (19 cohort studies, 2 observational studies, 2 case-control studies, 4 case reports, and 3 systematic reviews). Mental illness symptoms often precede a diagnosis of CD in children; however, we found only 2 articles on screening practices, limited to eating disorders. One study, a small clinical trial, recommended screening patients with severe anorexia nervosa. Another study, a retrospective chart review, surveyed emergency department visits for patients with eating disorders and did not recommend screening for CD. Conversely, a 2019 systematic review stressed the importance of screening for CD in outpatient psychiatric clinics, because the overall prevalence of psychiatric comorbidities is higher in those with CD or NCGS. CD is a common childhood autoimmune disease, with 1 in 100 children being affected. At least 1 out of 3 cases of CD are undiagnosed, suggesting a higher prevalence of mental health disorders linked to CD than expected. More studies are needed to inform screening practices for CD and NCGS in children and adolescents with mental illness. Understanding this association aids clinicians in diagnostic and treatment clarity and could result in mental illness symptom remission with the gluten-free diet.