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Nutrients 2018, 10(10), 1444; https://doi.org/10.3390/nu10101444 (registering DOI)

The Significance of Low Titre Antigliadin Antibodies in the Diagnosis of Gluten Ataxia

1
Academic Departments of Neurosciences and Neuroradiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
2
Departments of Gastroenterology, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
3
Departments of Dietetics, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
4
Departments of Immunology, Sheffield Teaching Hospitals NHS Trust, Sheffield S10 2JF, UK
*
Author to whom correspondence should be addressed.
Received: 6 September 2018 / Revised: 25 September 2018 / Accepted: 4 October 2018 / Published: 5 October 2018
(This article belongs to the Special Issue Extraintestinal Manifestations of Coeliac Disease)
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Abstract

Background: Patients with gluten ataxia (GA) without enteropathy have lower levels of antigliadin antibodies (AGA) compared to patients with coeliac disease (CD). Magnetic Resonance Spectroscopy (NAA/Cr area ratio) of the cerebellum improves in patients with GA following a strict gluten-free diet (GFD). This is associated with clinical improvement. We present our experience of the effect of a GFD in patients with ataxia and low levels of AGA antibodies measured by a commercial assay. Methods: Consecutive patients with ataxia and serum AGA levels below the positive cut-off for CD but above a re-defined cut-off in the context of GA underwent MR spectroscopy at baseline and after a GFD. Results: Twenty-one consecutive patients with GA were included. Ten were on a strict GFD with elimination of AGA, 5 were on a GFD but continued to have AGA, and 6 patients did not go on a GFD. The NAA/Cr area ratio from the cerebellar vermis increased in all patients on a strict GFD, increased in only 1 out of 5 (20%) patients on a GFD with persisting circulating AGA, and decreased in all patients not on a GFD. Conclusion: Patients with ataxia and low titres of AGA benefit from a strict GFD. The results suggest an urgent need to redefine the serological cut-off for circulating AGA in diagnosing GA. View Full-Text
Keywords: Gluten ataxia; antigliadin antibodies; coeliac disease; MR spectroscopy; gluten sensitive enteropathy; antigliadin antibody titre Gluten ataxia; antigliadin antibodies; coeliac disease; MR spectroscopy; gluten sensitive enteropathy; antigliadin antibody titre
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Hadjivassiliou, M.; Grünewald, R.A.; Sanders, D.S.; Zis, P.; Croall, I.; Shanmugarajah, P.D.; Sarrigiannis, P.G.; Trott, N.; Wild, G.; Hoggard, N. The Significance of Low Titre Antigliadin Antibodies in the Diagnosis of Gluten Ataxia. Nutrients 2018, 10, 1444.

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