Beyond the Gut: Psychosis as an Early Manifestation of Celiac Disease

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

American Journal of Gastroenterology

Abstract

Introduction: Neuropsychiatric manifestations are a rare but recognized complication of celiac disease/gluten sensitivity, occurring in up to 22% of patients: ranging from epilepsy, cerebellar ataxia, peripheral neuropathy, schizophrenia, anxiety, attention-deficit hyperactivity disorder, to depression. The proposed pathomechanism involves cross-reactivity to neural antigens, observed in about 42% of patients. Cross-reactivity to anti-ganglioside antibodies has been documented in patients with cerebellar ataxia and peripheral neuropathy. Schizophrenia, in particular, has strong evidence in case reports where a gluten-free diet led to earlier symptom relief. Conversely, gluten reintroduction led to symptom worsening. Case Description/Methods: A 25-year-old man presented with 6 months of fatigue, 6 kg weight loss, early satiety, and intermittent nausea. He also reported persecutory delusions, visual hallucinations, disorganized thinking, and mood disturbances. Multiple psychiatric evaluations failed to yield a Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis, and medications offered minimal relief. On exam, he had conjunctival pallor, muscle wasting, and a body mass index (BMI) of 17.2 kg/ m². He showed food aversion, particularly to wheat. There was no family history of celiac disease or eating disorders. Labs revealed microcytic hypochromic anemia (Hb 9.0 g/dL) and albumin of 3.5 g/ dL. Celiac serology was positive for anti-tTG immunoglobulin A and immunoglobulin G. Endoscopy showed scalloping and fissuring of duodenal folds. Duodenal biopsies confirmed celiac disease (Marsh III) with villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes. A strict gluten-free diet (GFD) led to marked improvement in psychiatric symptoms within 2 weeks. Delusions and hallucinations resolved entirely within a month, mood stabilized, and psychotropic medications were discontinued. Nutritional rehabilitation improved appetite, corrected anemia, and increased BMI to 21.4. The patient remains symptom-free on follow-up while continuing a GFD. Discussion: This case highlights the neuropsychiatric spectrum of celiac disease, which may precede or overshadow gastrointestinal symptoms. Gluten may trigger immune-mediated neuroinflammation or malabsorption, leading to mood disorders or psychosis. Guidelines recommend considering celiac disease in unexplained neuropsychiatric cases, especially with nutritional deficiencies. Early diagnosis prevents complications.

Volume

120

Issue

10S2

First Page

S1302

Comments

American College of Gastroenterology Annual Meeting, October 24-29, 2025, Phoenix, AZ

Last Page

S1303

DOI

10.14309/01.ajg.0001152892.33406.83

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