Small-fibre neuropathy in coeliac disease: a cross-sectional study.

Authors

Livia Sophie Lang, Panoraia Baka, Nikola Hauke, Hüseyin Uysal, Majd Abusaada, Marianne Hahn, Cora Rebhorn, Clemens Sommer, Frank Birklein, Violeta Dimova

Published in

Frontiers in neurology. Volume 17. Pages 1858125. Epub Aug 14, 2026.

Abstract

Coeliac disease (CD) is associated with neurological manifestations, including peripheral neuropathy. While sensorimotor neuropathy has been described, objective evidence for small-fibre neuropathy (SFN) in CD remains limited. We aimed to assess large- and small-fibre involvement in patients with CD with and without neuropathic symptoms using contemporary diagnostic standards.
In this cross-sectional study, 36 adults with biopsy-proven CD were recruited nationwide and stratified by the Neuropathy Symptom Score into symptomatic (pwCD(NS+), NSS ≥ 3) and asymptomatic (pwCD(NS-), NSS < 3) groups. All participants underwent neurological examination, sural nerve conduction studies (NCS), quantitative sensory testing (QST), distal leg skin biopsy for intraepidermal nerve fibre density (IENFD), and autonomic testing.
pwCD(NS+) predominantly reported distal symmetric sensory complaints with neuropathic pain characteristics. NCS were normal in both groups, arguing against relevant sensorimotor neuropathy. Both groups showed a loss-of-function QST profile with impaired thermal detection. IENFD was lower in pwCD(NS+) than in pwCD(NS-) and correlated with symptom severity. Autonomic testing was largely unremarkable. 50% of pwCD(NS+) fulfilled the diagnostic criteria for SFN, while all remaining patients showed abnormalities in at least one small fibre-related domain (clinical examination, IENFD or QST). In pwCD(NS-), isolated abnormalities in QST or IENFD were frequently observed despite the absence of neuropathic symptoms.
In CD, neuropathic symptoms are associated with small-fibre pathology rather than sensorimotor neuropathy. SFN should be considered in the diagnostic work-up of neuropathic complaints in CD, and symptom-oriented treatment is warranted.

PMID:
42666168
Bibliographic data and abstract were imported from PubMed on 29 Aug 2026.

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