IMMUNOLOGICAL GLUTEN SENSITIVITY IN UNDERWEIGHT PATIENTS WITH EATING DISORDER

Abstract Aims Gluten sensitivity is a syndrome characterized by several physical and psychological symptoms such as abdominal pain, constipation, diarrhea, headache, foggy brain, tiredness, anxiety, and depression, related to the ingestion of gluten. In recent years, it has been reported that gluten sensitivity is associated with various psychiatric disorders, and anti-gliadin IgG antibodies have been established as a biomarker for gluten sensitivity, but diagnostic criteria have not yet been established and the actual status of gluten sensitivity remains unclear. Eating disorders are psychiatric disorders that are often difficult to treat, especially recovery from low body weight. Low body weight often results in constipation due to decreased gastrointestinal activity, but occasionally patients complain of diarrhea and many patients complain of strong discomfort and physical symptoms after food ingestion. We conducted a study to investigate immunological gluten sensitivity in eating disorder patients with low body weight. Methods The subjects were 18 underweight female patients with eating disorders who visited the outpatient clinic of the Department of Psychiatry and Neurology, Hyogo Medical University Hospital and were confirmed to be free from laxative abuse, and 43 age-sex-matched healthy subjects. Blood samples were collected and gluten-related antibodies such as anti-gliadin IgG antibodies were measured by ELISA, and psychiatric and physical symptoms were assessed by interview and self- administered questionnaire. This study was approved by the Ethics Committee of Hyogo Medical University (No. 3412) and written consent was obtained from the subjects. Results 18 subjects included 10 patients with anorexia nervosa, 7 patients with avoidant restrictive food intake disorder, and 1 patient with other identified eating behavior disorders or eating disorders. In the eating disorder group, the positivity rate of anti-gliadin IgG antibodies was 50%, significantly higher than the 11.6% of the healthy subjects (p=2.3 x 10-3). The antibody positivity rate in patients with diarrhea was 85.7%. Eating disorder patients with immunological gluten sensitivity showed significantly lower mental quality of life, more physical symptoms, and more depressive and anxiety symptoms than the healthy group, but not significantly different from the group without immunological gluten sensitivity. Two patients with anorexia nervosa who were positive for anti-gliadin IgG antibodies were introduced to a gluten-free diet during outpatient care after the discovery of immunological gluten sensitivity and showed clear weight gain. Conclusion The relationship of gluten sensitivity in underweight patients with eating disorders is suggested. Considering the pathophysiology of low nutritional status, underweight patients with eating disorders who is more likely to be constipated, but when diarrhea is present, gluten intolerance should be considered.