Narrative review examines neuropsychiatric manifestations of celiac disease in pediatric and adult populationsGluten-free diets help some people with celiac disease feel better but not everyone gets better

Frontiers in Medicine Published May 14, 2026 DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Consider early identification and multidisciplinary management for celiac disease to prevent irreversible neurological damage.

This narrative review addresses neuropsychiatric manifestations in patients with celiac disease across pediatric and adult populations. The scope includes neurological features, psychiatric manifestations, underlying mechanisms, clinical implications, and therapeutic perspectives. The review does not report specific sample sizes or numerical outcomes for individual studies.

Neurological features described include cerebellar ataxia, peripheral neuropathy, epilepsy, headache, cognitive dysfunction, and sleep disorders. Psychiatric manifestations encompass depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, and schizophrenia. The review indicates that some patients improve with a gluten-free diet, while others experience persistent symptoms despite strict dietary adherence. Pediatric patients usually exhibit lower prevalence and milder neurological involvement.

The authors state that in some patients, neuropsychiatric manifestations are directly evoked by gluten exposure. In others, gluten acts as a trigger of self-perpetuating neuroimmune or neuroinflammatory cascades. A key limitation identified is that the pathophysiology and clinical relevance are still partly understood. The review concludes that early identification, multidisciplinary management, and strict dietary monitoring are essential to prevent irreversible neurological damage and optimize long-term outcomes.

Celiac disease is an illness where eating gluten makes the stomach hurt. This condition can also cause problems with the brain and mood. Doctors have found many different issues, like trouble walking, seizures, and feeling sad or worried. Some people also have trouble focusing or sleeping well.

Children with this disease usually have fewer brain problems than adults. However, both groups can still have trouble even when they stop eating gluten. The reasons for these brain issues are not fully understood by doctors yet.

Eating a diet without gluten helps many patients feel better over time. But some people keep having symptoms even when they follow the diet perfectly. This means the diet is not a fix for everyone. Doctors must watch patients carefully to make sure they are getting better.

Finding problems early and working with a team of doctors is very important. This helps stop long-term damage to the brain. Some patients get sick because of gluten directly. Others get sick because gluten starts a chain reaction in the body that keeps going.

What this means for you:

A gluten-free diet helps many patients, but some still have symptoms. Early care and strict monitoring are needed for the best results.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundCeliac disease (CeD) is a systemic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals. Further to the gastrointestinal involvement, growing evidence highlights a wide spectrum of neurological and psychiatric manifestations, with still partly understood pathophysiology and clinical relevance.AimsThis narrative review provides an updated appraisal of neuropsychiatric conditions associated with CeD, discussing their underlying mechanisms, clinical implications, and therapeutic perspectives, with particular attention to differences between paediatric and adult populations.MethodsA comprehensive literature review was conducted focusing on neurological and psychiatric complications of CD, proposed pathogenetic pathways, and outcomes following a gluten-free diet (GFD).ResultsNeurological features include cerebellar ataxia, peripheral neuropathy, epilepsy, headache, cognitive dysfunction, and sleep disorders; psychiatric manifestations encompass depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders, and schizophrenia. Possible underlying mechanisms involve autoimmune responses (anti-transglutaminase 6 antibodies), blood-brain barrier dysfunction, gut dysbiosis, neuroinflammation, micronutrient deficiencies, serotonergic dysregulation, and cerebral perfusion abnormalities. Clinical outcomes vary as some patients improve on a GFD, while others experience persistent symptoms despite strict dietary adherence. Paediatric patients usually exhibit lower prevalence and milder neurological involvement, likely due to early diagnosis and better compliance.ConclusionsNeuropsychiatric manifestations are clinically significant yet frequently underrecognized components of CeD. In some patients, they are directly evoked by gluten exposure; in others, gluten acts as a trigger of self-perpetuating neuroimmune or neuroinflammatory cascades. Early identification, multidisciplinary management, and strict dietary monitoring are essential to prevent irreversible neurological damage and optimize long-term outcomes.

Narrative review examines neuropsychiatric manifestations of celiac disease in pediatric and adult populationsGluten-free diets help some people with celiac disease feel better but not everyone gets better

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Narrative review examines neuropsychiatric manifestations of celiac disease in pediatric and adult populationsGluten-free diets help some people with celiac disease feel better but not everyone gets better

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