Is there a relationship between gluten sensitivity and postural tachycardia syndrome?
Penny H, Aziz I, Ferrar M et al
European Journal of Gastroenterology & Hepatology 2016 Dec;28(12):1383-1387
Alongside the more classical presentation of coeliac disease, patients with this condition frequently report a range of extraintestinal symptoms, including those that may be related to the autonomic nervous system, including palpitations, dizziness and presyncope (1-3), the nature of this association remains unclear.
European Journal of Gastroenterology & Hepatology 2016 Dec;28(12):1383-1387
Alongside the more classical presentation of coeliac disease, patients with this condition frequently report a range of extraintestinal symptoms, including those that may be related to the autonomic nervous system, including palpitations, dizziness and presyncope (1-3), the nature of this association remains unclear.
Postural tachycardia syndrome (PoTS) is a type of autonomic dysfunction that falls under the umbrella term of ‘orthostatic intolerance’, and is characterised by light-headedness and dizziness, accompanied by excessive increase in heart rate on standing. Patients with PoTS often present with symptoms outside of the cardiovascular system, including GI complaints (4).
Over recent years, clinicians working within the complex syncope clinic at the Royal Hallamshire Hospital in Sheffield have noted that a large number of patients with PoTS have self-imposed and maintained a gluten-free diet to help with symptom control. In light of this observation, this retrospective study sought to further investigate this relationship and evaluate the prevalence of CD in a cohort of patients with PoTS compared with local population data. Furthermore, the frequency of self-reported gluten sensitivity in PoTS and an age-matched and sex-matched control population was also evaluated.
One hundred patients (>18 years) with diagnosed PoTS were recruited to take part in the study between May 2013-May 2015. Patients completed a modified, validated questionnaire to determine demographic, dietary and GI symptom data. Case notes for subjects were also reviewed for evidence of CD diagnosis, as confirmed by positive coeliac serology and duodenal biopsy. For comparison, local coeliac prevalence was determined by evaluation of serology and histology from a historical cohort of 1200 controls (control group 1). A further 400 age and sex matched controls were recruited from shopping centres and transport stations, and asked to complete the same questionnaire (control group 2).
Of the patients with PoTS, 4/100 (4%) had biopsy proven CD, significantly higher than the general population CD prevalence of 1% (control group 1). PoTS patients had a higher prevalence of self-reported gluten sensitivity compared with controls (42% v’s 19%, p<0.001). Within the PoTS group, 27% were following a gluten-free diet. This was significantly higher than the reported consumption of a gluten-free diet amongst the control group 2 population (4%. p<0.001), a further 6% of PoTS patients reported to have previously tried a gluten-free diet.
This is the first study to suggest a potential association between gluten-related disorders and PoTS. A prospective study with appropriately matched controls to evaluate this relationship further may enable a better understanding regarding the management of these conditions.
Link to original paper
Ref’s:
Over recent years, clinicians working within the complex syncope clinic at the Royal Hallamshire Hospital in Sheffield have noted that a large number of patients with PoTS have self-imposed and maintained a gluten-free diet to help with symptom control. In light of this observation, this retrospective study sought to further investigate this relationship and evaluate the prevalence of CD in a cohort of patients with PoTS compared with local population data. Furthermore, the frequency of self-reported gluten sensitivity in PoTS and an age-matched and sex-matched control population was also evaluated.
One hundred patients (>18 years) with diagnosed PoTS were recruited to take part in the study between May 2013-May 2015. Patients completed a modified, validated questionnaire to determine demographic, dietary and GI symptom data. Case notes for subjects were also reviewed for evidence of CD diagnosis, as confirmed by positive coeliac serology and duodenal biopsy. For comparison, local coeliac prevalence was determined by evaluation of serology and histology from a historical cohort of 1200 controls (control group 1). A further 400 age and sex matched controls were recruited from shopping centres and transport stations, and asked to complete the same questionnaire (control group 2).
Of the patients with PoTS, 4/100 (4%) had biopsy proven CD, significantly higher than the general population CD prevalence of 1% (control group 1). PoTS patients had a higher prevalence of self-reported gluten sensitivity compared with controls (42% v’s 19%, p<0.001). Within the PoTS group, 27% were following a gluten-free diet. This was significantly higher than the reported consumption of a gluten-free diet amongst the control group 2 population (4%. p<0.001), a further 6% of PoTS patients reported to have previously tried a gluten-free diet.
This is the first study to suggest a potential association between gluten-related disorders and PoTS. A prospective study with appropriately matched controls to evaluate this relationship further may enable a better understanding regarding the management of these conditions.
Link to original paper
Ref’s:
- Hadjivassiliou M, Grünewald RA, Davies-Jones GA. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry 2002; 72:560–563.
- Johnston SD, Watson RG, McMillan SA, Sloan J, Love AH. Prevalence of coeliac disease in Northern Ireland. Lancet 1997; 350:1370.
- Gibbons CH, Freeman R. Autonomic neuropathy and coeliac disease. J Neurol Neurosurg Psychiatry 2005; 76:579–581.
- Mathias CJ, Low DA, Iodice V. Postural tachycardia syndrome – current experience and concepts Nat. Rev Neurol 2012; 8:22–34.
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