Coeliac

FIL put up with being a severe celiac for more than fifty years, so this advertisement which arrived from Elsevier this morning caught my eye. He very interested in medical matters, including his own, and would no doubt have been keen to read this paper, detailed at reference 1 below.

"Abstract: celiac disease (CD) is a systemic, chronic immune-mediated disorder elicited by gluten and related prolamines in genetically susceptible subjects. Main manifestations of CD involve the digestive tract; however, a growing body of evidence supports the theory that symptoms may occur in every part of the body. It is known that some patients with CD can be asymptomatic, and additionally, the incidence of "nonclassical" CD with extra-intestinal presentation is apparently increasing. We aimed to perform a thorough review of existing evidence for neurological manifestations of CD, providing an up-to-date description of prevalence and examining the pathogenetic mechanisms possibly involved. Neurological presentations are rare in children but as many as 36% of adult patients present with neurological findings. With severe malnutrition after progression of CD, different vitamin deficiencies may develop. Such problems can in turn overlap with previous neurological abnormalities including ataxia, epilepsy, neuropathy, dementia, and cognitive disorders. Here, the most prevalent clinical manifestations in adults and children have been discussed in further detail. Further research is needed to achieve a complete understanding of the nervous system involvement in CD, but clinicians should always remember that neurological and psychiatric symptoms might be part of the CD spectrum of manifestations".

Note the interesting concept of a disease without symptoms, asymptomatic in the jargon. Not the sort of disease that the old masters, that is to say Hippocrates (the chap who invented the oath, not, apparently, actually taken by neophyte doctors) or Galen (Turkish-Greek, a concept not recognised since 1920 or so), would recognise.

Available for free from ResearchGate if you prefer not to pay money to Elsevier.

But I think I shall pass. I don't think I need to know about all these wider ramifications of what I had taken to be a disorder of the large intestine - and we shall let FIL rest in peace. Faults and all.

Reference 1: Neuropsychiatric manifestations in celiac disease - Chiara Maria Trovato, Umberto Raucci, Francesco Valitutti, Maria Pia Villa, Salvatore Cucchiara, Pasquale Parisi - 2019.