Editorial
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 14, 2009; 15(38): 4741-4744
Published online Oct 14, 2009. doi: 10.3748/wjg.15.4741
Adult celiac disease with acetylcholine receptor antibody positive myasthenia gravis
Hugh J Freeman, Helen R Gillett, Peter M Gillett, Joel Oger
Hugh J Freeman, Helen R Gillett, Peter M Gillett, Joel Oger, Department of Medicine (Gastroenterology and Neurology), University of British Columbia, Vancouver, BC, V6T 1W5, Canada
Author contributions: Freeman HJ, Gillett HR, Gillett PM, Oger J contributed equally to this work; Oger J provided stored serum samples from myasthenia gravis patients; Freeman HJ, Gillett HR and Oger J designed the research; Freeman HJ and Gillett PM performed small bowel biopsy studies; Freeman HJ provided reagents and analytical tools and Gillett HR performed tissue transglutaminase assays; Freeman HJ, Gillett HR, Gillett PM, Oger J analyzed the data and wrote the paper.
Correspondence to: Dr. Hugh J Freeman, Department of Medicine (Gastroenterology and Neurology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 1W5, Canada. hugfree@shaw.ca
Telephone: +1-604-8227216 Fax: +1-604-8227236
Received: June 1, 2009
Revised: September 8, 2009
Accepted: September 15, 2009
Published online: October 14, 2009
Abstract

Celiac disease has been associated with some autoimmune disorders. A 40-year-old competitive strongman with celiac disease responded to a gluten-free diet, but developed profound and generalized motor weakness with acetylcholine receptor antibody positive myasthenia gravis, a disorder reported to occur in about 1 in 5000. This possible relationship between myasthenia gravis and celiac disease was further explored in serological studies. Frozen stored serum samples from 23 acetylcholine receptor antibody positive myasthenia gravis patients with no intestinal symptoms were used to screen for celiac disease. Both endomysial and tissue transglutaminase antibodies were examined. One of 23 (or, about 4.3%) was positive for both IgA-endomysial and IgA tissue transglutaminase antibodies. Endoscopic studies subsequently showed duodenal mucosal scalloping and biopsies confirmed the histopathological changes of celiac disease. Celiac disease and myasthenia gravis may occur together more often than is currently appreciated. The presence of motor weakness in celiac disease may be a clue to occult myasthenia gravis, even in the absence of intestinal symptoms.

Keywords: Acetylcholine receptor antibodies; Celiac disease; Myasthenia gravis; Transglutaminase antibodies