Narrative review examines neuropsychiatric manifestations of celiac disease in pediatric and adult populations

Photo by Robina Weermeijer / Unsplash

Frontiers in Medicine Published May 14, 2026 Medically reviewed May 14, 2026 DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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.

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.