Abstract
Gluten-related disorders are characterized by both intestinal and extraintestinal manifestations. Previous studies have suggested an association between gluten-related disorder and psychiatric comorbidities. The objective of our current review is to provide a comprehensive review of this association in children and adults. A systematic literature search using MEDLINE, Embase and PsycINFO from inception to 2018 using terms of ‘celiac disease’ or ‘gluten-sensitivity-related disorders’ combined with terms of ‘mental disorders’ was conducted. A total of 47 articles were included in our review, of which 28 studies were conducted in adults, 11 studies in children and eight studies included both children and adults. The majority of studies were conducted in celiac disease, two studies in non-celiac gluten sensitivity and none in wheat allergy. Enough evidence is currently available supporting the association of celiac disease with depression and, to a lesser extent, with eating disorders. Further investigation is warranted to evaluate the association suggested with other psychiatric disorders. In conclusion, routine surveillance of potential psychiatric manifestations in children and adults with gluten-related disorders should be carried out by the attending physician.
Highlights
Gluten-related disorders include three pathologies caused by the ingestion of gluten-containing cereals grains, namely celiac disease (CD), non-celiac gluten sensitivity (NCGS) and wheat allergy (WA) [1]
In the cohort study conducted by Ludvigsson et al [34], it was shown that adults and children with CD are at increased risk of being diagnosed with depression but not bipolar disorder later in life, whereas in the study conducted by Butwicka et al [44], CD was identified as a risk factor for mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability diagnosed prior to 18 years of age
Our current comprehensive review ascertains the presence of an association between CD and psychiatric disorders with varying grades of evidence from one condition to another
Summary
Gluten-related disorders include three pathologies caused by the ingestion of gluten-containing cereals grains, namely celiac disease (CD), non-celiac gluten sensitivity (NCGS) and wheat allergy (WA) [1]. Celiac disease is a systemic autoimmune disease due to a permanent intolerance to gluten which causes villous atrophy of the intestinal mucosa. It involves both innate and adaptive immune responses that appear in genetically predisposed subjects exposed to gluten and, unlike food allergies, it is not mediated by an immediate hypersensitivity reaction. It is a polygenic multifactorial disorder whose development depends on the genetic constitution of the subject, on his/her exposure to gluten intake, and on different environmental factors [2,3]. The only effective treatment for the disease is to observe a life-long strict gluten-free diet other therapeutic approaches are being explored [4]
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